MEDICARE: AURELIO PERFORMANCE PHYSICAL THERAPY OF SCOTTSDALE LLC

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	261QP2000X	Physical Therapy Clinic/Center
2	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1609581123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURELIO PERFORMANCE PHYSICAL THERAPY OF SCOTTSDALE LLC

Provider Business Mailing Address
First Line	:	12627 E CENTRAL AVE STE 308
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-2839
Country	:	US
Telephone Number	:	316-260-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	8010 E MCDOWELL RD STE 113
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-3868
Country	:	US
Telephone Number	:	316-260-3311
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS OPERATIONS
Name	:	LOGAN MADDING
Credential	:
Telephone Number	:	316-260-3311

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	05/08/2023

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