Provider Demographics
NPI:1356680540
Name:ADVANCED PHYSICAL MEDICINE LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HATZENBELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-632-0177
Mailing Address - Street 1:4365 E PECOS RD STE 129
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8052
Mailing Address - Country:US
Mailing Address - Phone:480-632-0177
Mailing Address - Fax:480-632-5195
Practice Address - Street 1:4365 E PECOS RD STE 129
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8052
Practice Address - Country:US
Practice Address - Phone:480-632-0177
Practice Address - Fax:480-632-5195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40474208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty