Provider Demographics
NPI:1235405093
Name:FLAMAND, JANELL MARIE (PT)
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:MARIE
Last Name:FLAMAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 W WICKENBURG WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-2262
Mailing Address - Country:US
Mailing Address - Phone:928-668-0108
Mailing Address - Fax:
Practice Address - Street 1:1175 W WICKENBURG WAY STE 3
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-2262
Practice Address - Country:US
Practice Address - Phone:928-668-0108
Practice Address - Fax:928-668-0110
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3331225100000X
AZ9489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP01623027OtherRAILROAD MEDICARE
AZZ186361OtherMEDICARE
AZ104798Medicaid