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NPI Code Detail

MEDICARE: MONICA IDSTEIN PT, DPT

MEDICARE: MONICA IDSTEIN PT, 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
1225100000XPhysical Therapist10501AZ

General Provider Information

NPI Number : 1992104426
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA IDSTEIN PT, DPT
Provider Business Mailing Address
First Line : 1190 E MISSOURI AVE STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-2719
Country : US
Telephone Number : 602-393-0520
Fax Number : 602-393-0523
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 : 602-393-0520
Fax Number : 602-393-0523
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2014
Last Update Date : 08/20/2014

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