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NPI Code Detail

MEDICARE: WING NEUROLOGICAL REHAB

MEDICARE: WING NEUROLOGICAL REHAB
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
1261QR0401XComprehensive Outpatient Rehabilitation Facility (CORF)TSLP7413AZ

General Provider Information

NPI Number : 1831470103
Entity Type Code : Organization
Provider Name (Legal Business Name) : WING NEUROLOGICAL REHAB
Provider Business Mailing Address
First Line : 1190 E MISSOURI AVE. SUITE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85014
Country : US
Telephone Number : 480-567-6717
Fax Number :
Provider Business Practice Location Address
First Line : 1190 E MISSOURI AVE STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-2719
Country : US
Telephone Number : 480-567-6717
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MARY K. WING
Credential :
Telephone Number : 602-393-0520
Provider Enumeration Date : 08/31/2011
Last Update Date : 09/16/2011

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Directions to “WING NEUROLOGICAL REHAB ” Practice Location

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