Provider Demographics
NPI:1376788463
Name:AZ HAND CENTER AND PHYSICAL REHAB
Entity Type:Organization
Organization Name:AZ HAND CENTER AND PHYSICAL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR/PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:NAMIHAS
Authorized Official - Suffix:
Authorized Official - Credentials:OT/CHT
Authorized Official - Phone:928-777-9890
Mailing Address - Street 1:710 S MONTEZUMA ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4230
Mailing Address - Country:US
Mailing Address - Phone:928-541-1964
Mailing Address - Fax:
Practice Address - Street 1:3108 CLEARWATER DR STE B2
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7170
Practice Address - Country:US
Practice Address - Phone:928-777-9890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty