Provider Demographics
NPI:1114232337
Name:PHUSION REHAB
Entity Type:Organization
Organization Name:PHUSION REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WOFFINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-535-2242
Mailing Address - Street 1:2036 N GILBERT RD
Mailing Address - Street 2:SUITE 2-151
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2139
Mailing Address - Country:US
Mailing Address - Phone:602-535-2242
Mailing Address - Fax:602-680-5169
Practice Address - Street 1:2036 N GILBERT RD
Practice Address - Street 2:SUITE 2-151
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2139
Practice Address - Country:US
Practice Address - Phone:602-535-2242
Practice Address - Fax:602-680-5169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5823261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy