Provider Demographics
NPI:1205370913
Name:STRATTON RODEO SPORTS MEDICINE
Entity Type:Organization
Organization Name:STRATTON RODEO SPORTS MEDICINE
Other - Org Name:STRATTON SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:DSC, PT, ATC, MA
Authorized Official - Phone:602-284-5530
Mailing Address - Street 1:415 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-3103
Mailing Address - Country:US
Mailing Address - Phone:602-284-5530
Mailing Address - Fax:
Practice Address - Street 1:415 S 31ST ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-3103
Practice Address - Country:US
Practice Address - Phone:602-284-5530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy