Provider Demographics
NPI:1134317779
Name:FOOTHILLS SPORTS MEDICINE & REHABILITATION LITCHFIELD PARK, LLC
Entity Type:Organization
Organization Name:FOOTHILLS SPORTS MEDICINE & REHABILITATION LITCHFIELD PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:623-547-4739
Mailing Address - Street 1:5110 N DYSART RD
Mailing Address - Street 2:SUITE 148
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3058
Mailing Address - Country:US
Mailing Address - Phone:623-547-4739
Mailing Address - Fax:623-536-2154
Practice Address - Street 1:5110 N DYSART RD
Practice Address - Street 2:SUITE 148
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-3058
Practice Address - Country:US
Practice Address - Phone:623-547-4739
Practice Address - Fax:623-536-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty