MEDICARE: METRO PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1457403602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	10000 N 31ST AVE #A102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9568
Country	:	US
Telephone Number	:	602-866-0066
Fax Number	:	602-866-3868

Provider Business Practice Location Address
First Line	:	11225 N 28TH DR STE F100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5606
Country	:	US
Telephone Number	:	602-866-0066
Fax Number	:	602-866-3868

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL L BASTEN
Credential	:
Telephone Number	:	480-689-5515

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	03/18/2020

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Directions to “METRO PHYSICAL THERAPY PC ” Practice Location

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