Provider Demographics
NPI:1104187889
Name:ARIZONA SPORTS & REHABILITATION PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ARIZONA SPORTS & REHABILITATION PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WEISFLOG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-663-7829
Mailing Address - Street 1:8114 E CACTUS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5260
Mailing Address - Country:US
Mailing Address - Phone:480-663-7829
Mailing Address - Fax:480-998-0629
Practice Address - Street 1:8114 E CACTUS RD STE 220
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5260
Practice Address - Country:US
Practice Address - Phone:480-663-7829
Practice Address - Fax:480-998-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ71932251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty