MEDICARE: DR. MARK WILLIAM DARDIS N.D., ED.D., D.P.T.

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	175F00000X	Naturopath	21-00039	KS
2	225100000X	Physical Therapist	11-00596	KS
3	225100000X	Physical Therapist	8414	AZ
4	2251H1200X	Hand Physical Therapist	9310000379	CA
5	175F00000X	Naturopath	16-1548	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710067681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK WILLIAM DARDIS N.D., ED.D., D.P.T.

Provider Business Mailing Address
First Line	:	15424 S 1ST AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85045-0400
Country	:	US
Telephone Number	:	480-460-0669
Fax Number	:

Provider Business Practice Location Address
First Line	:	15424 S 1ST AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85045-0400
Country	:	US
Telephone Number	:	480-460-0669
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	05/10/2019

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