Provider Demographics
NPI:1437347069
Name:POPP, RAYMOND (MPT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:POPP
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14815 W BELL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7603
Mailing Address - Country:US
Mailing Address - Phone:602-377-1178
Mailing Address - Fax:623-825-7193
Practice Address - Street 1:14815 W BELL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7603
Practice Address - Country:US
Practice Address - Phone:602-377-1178
Practice Address - Fax:623-825-7193
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8250225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist