MEDICARE: ELIZABETH ANN MCNABB DPT

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	174400000X	Specialist	2162	NV
2	225100000X	Physical Therapist	35726	CA
3	225100000X	Physical Therapist	013642	OH
4	2251X0800X	Orthopedic Physical Therapist	10205	AZ
5	225100000X	Physical Therapist	LPT-01025	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	:	1891970216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN MCNABB DPT

Provider Business Mailing Address
First Line	:	2108 E THOMAS RD STE 130
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7761
Country	:	US
Telephone Number	:	602-933-3124
Fax Number	:	480-895-9471

Provider Business Practice Location Address
First Line	:	3530 S VAL VISTA DR STE B205
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-7318
Country	:	US
Telephone Number	:	602-933-7528
Fax Number	:

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

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	07/26/2022

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