Provider Demographics
NPI:1376638452
Name:ARIZONA INDUSTRIAL, SPORT & SPINE, INC.
Entity Type:Organization
Organization Name:ARIZONA INDUSTRIAL, SPORT & SPINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CORPORATE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-897-9016
Mailing Address - Street 1:1006 E. WARNER RD.
Mailing Address - Street 2:SUITE 114
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3216
Mailing Address - Country:US
Mailing Address - Phone:480-897-9016
Mailing Address - Fax:480-897-9210
Practice Address - Street 1:1006 E. WARNER RD.
Practice Address - Street 2:SUITE 114
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3216
Practice Address - Country:US
Practice Address - Phone:480-897-9016
Practice Address - Fax:480-897-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21132251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ670917OtherACN
AZ7799540OtherAETNA
AZA-100786OtherMULTI PLAN
AZQH9011OtherEMPIRE BC/BS
AZTC00885OtherTRI CARE
AZ2Z9327OtherHEALTH NET
AZA-100786OtherBCE EMERGIS
AZAZ0462410OtherBLUE CROSS BLUE SHIELD
AZ497630OtherONE HEALTH
AZTC00885OtherTRI CARE