Provider Demographics
NPI:1245411610
Name:GEORGE, SUNIL SAM (PT)
Entity Type:Individual
Prefix:MR
First Name:SUNIL
Middle Name:SAM
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8685 W. UNION HILLS DR.
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:623-486-2331
Mailing Address - Fax:623-486-3136
Practice Address - Street 1:2525 W. CAREFREE HIGHWAY BLDG. 5 #136
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085
Practice Address - Country:US
Practice Address - Phone:623-580-0111
Practice Address - Fax:623-580-9080
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7734OtherSTATE LICENSE