MEDICARE: ACCELERATED REHABILITATION CENTERS OF PHOENIX LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist
3	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1629633367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCELERATED REHABILITATION CENTERS OF PHOENIX LLC

Provider Business Mailing Address
First Line	:	600 OAKMONT LN STE 600C
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 N STAPLEY DR STE 105
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-7281
Country	:	US
Telephone Number	:	480-729-8317
Fax Number	:	480-542-6462

Authorized Official
Title or Position	:	CREDENTAILING MANAGER
Name	:	JUANA GRANADOS
Credential	:
Telephone Number	:	630-575-1980

Provider Enumeration Date	:	05/08/2019
Last Update Date	:	05/08/2019

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