Provider Demographics
NPI:1073705687
Name:ADVANCED PHYSIOTHERAPY & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSIOTHERAPY & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-242-0000
Mailing Address - Street 1:8129 N 35TH AVE
Mailing Address - Street 2:#3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-5892
Mailing Address - Country:US
Mailing Address - Phone:602-242-0000
Mailing Address - Fax:602-995-4444
Practice Address - Street 1:8129 N 35TH AVE
Practice Address - Street 2:#3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-5892
Practice Address - Country:US
Practice Address - Phone:602-242-0000
Practice Address - Fax:602-995-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
AZ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty