NPI 1114274784 · live from the CMS NPI Registry
Adult And Pediatric Rehabilitation
Physical Therapist in San Luis, AZ. National Provider Identifier 1114274784, active.
NPI record
| NPI | 1114274784 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Physical Therapist 225100000X |
| Practice location | 1453 N Main Street, 7, San Luis, AZ 85349 |
| Practice phone | 928-722-6050 |
| Mailing address | Po Box 5841, Yuma, AZ 85366 |
| Enumerated | August 13, 2012 |
| Last updated | April 1, 2024 |
| Authorized official | Sergio Macias, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physical Therapist primary | 225100000X | 4229 (AZ) |
| Durable Medical Equipment & Medical Supplies | 332B00000X | C001071 (AZ) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.