Provider Demographics
NPI:1073515235
Name:NORTHERN ARIZONA REHABILITATION & FITNESS
Entity Type:Organization
Organization Name:NORTHERN ARIZONA REHABILITATION & FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-649-9726
Mailing Address - Street 1:450 S WILLARD ST
Mailing Address - Street 2:STE 106
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6744
Mailing Address - Country:US
Mailing Address - Phone:928-649-9726
Mailing Address - Fax:928-634-2079
Practice Address - Street 1:450 S WILLARD ST
Practice Address - Street 2:STE 106
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6744
Practice Address - Country:US
Practice Address - Phone:928-649-9726
Practice Address - Fax:928-634-2079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13044799E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ495516Medicaid
AZ70362Medicare ID - Type Unspecified