MEDICARE: FOOTHILLS SPORTS MEDICINE AND REHABILITATION, 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	225100000X	Physical Therapist	2252	AZ

General Provider Information

NPI Number	:	1740283274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTHILLS SPORTS MEDICINE AND REHABILITATION, SCOTTSDALE, LLC

Provider Business Mailing Address
First Line	:	5410 N. SCOTTSDALE RD
Second Line	:	SUITE A 100
City	:	PARADISE VALLEY
State	:	AZ
Zip	:	85253-4433
Country	:	US
Telephone Number	:	480-609-0822
Fax Number	:	480-609-0828

Provider Business Practice Location Address
First Line	:	5410 N. SCOTTSDALE RD
Second Line	:	SUITE A 100
City	:	PARADISE VALLEY
State	:	AZ
Zip	:	85253-4433
Country	:	US
Telephone Number	:	480-609-0822
Fax Number	:	480-609-0828

Authorized Official
Title or Position	:	PHYSICAL THERAPIST, OWNER
Name	:	ANDY MORIARTY
Credential	:	PT
Telephone Number	:	480-609-0822

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	04/18/2022

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