Provider Demographics
NPI:1225605421
Name:AWAD, GEORGE (MMT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:AWAD
Suffix:
Gender:M
Credentials:MMT
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:
Other - Last Name:OSARRAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MMT
Mailing Address - Street 1:254 N 79TH WAY
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-7557
Mailing Address - Country:US
Mailing Address - Phone:480-202-0456
Mailing Address - Fax:
Practice Address - Street 1:425 W GUADALUPE RD STE 114
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3203
Practice Address - Country:US
Practice Address - Phone:480-202-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-23300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist