Provider Demographics
NPI:1073802542
Name:SPRINGBOK WELLNESS AND REHAB L.L.C.
Entity Type:Organization
Organization Name:SPRINGBOK WELLNESS AND REHAB L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:BRENDON
Authorized Official - Last Name:GIBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-558-0474
Mailing Address - Street 1:1400 N GILBERT RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2328
Mailing Address - Country:US
Mailing Address - Phone:480-558-0474
Mailing Address - Fax:480-558-0478
Practice Address - Street 1:1400 N GILBERT RD
Practice Address - Street 2:SUITE M
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2328
Practice Address - Country:US
Practice Address - Phone:480-558-0474
Practice Address - Fax:480-558-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty