Provider Demographics
NPI:1215362967
Name:ARIZONA SPORTS AND REHABILITATION
Entity Type:Organization
Organization Name:ARIZONA SPORTS AND REHABILITATION
Other - Org Name:ARIZONA REHAB AND PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:A
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
Mailing Address - Street 2:SUITE 220
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:
Practice Address - Street 1:8114 E CACTUS RD
Practice Address - Street 2:STE 220
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty