Provider Demographics
NPI:1164980389
Name:PRECISION PHYSICAL THERAPY AND SPORTS MEDICINE, PLLC
Entity Type:Organization
Organization Name:PRECISION PHYSICAL THERAPY AND SPORTS MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAIFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-692-2110
Mailing Address - Street 1:422 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5214
Mailing Address - Country:US
Mailing Address - Phone:480-497-9399
Mailing Address - Fax:
Practice Address - Street 1:422 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5214
Practice Address - Country:US
Practice Address - Phone:480-497-9399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1154621381Medicaid