MEDICARE: LIESL B IAEGER PT, DPT

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	11775PT	AZ

General Provider Information

NPI Number	:	1548636806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIESL B IAEGER PT, DPT

Provider Business Mailing Address
First Line	:	201 W GUADALUPE RD SUITE 313
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233
Country	:	US
Telephone Number	:	480-892-0808
Fax Number	:	480-892-6045

Provider Business Practice Location Address
First Line	:	201 W GUADALUPE RD STE 313
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-3334
Country	:	US
Telephone Number	:	480-892-0808
Fax Number	:	480-890-6045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2015
Last Update Date	:	07/21/2022

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