MEDICARE: FOOTWORKS PHYSICAL THERAPY, PLLC

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	5703	AZ

General Provider Information

NPI Number	:	1932417508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTWORKS PHYSICAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	4530 N 32ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3357
Country	:	US
Telephone Number	:	480-518-0458
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 N 32ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3357
Country	:	US
Telephone Number	:	480-518-0458
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINA MARIE D'AMBROSIO
Credential	:	MS, PT
Telephone Number	:	480-518-0458

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	09/17/2010

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