Provider Demographics
NPI:1447381587
Name:PHYSICO HEALTH ASSSESSMENTS
Entity Type:Organization
Organization Name:PHYSICO HEALTH ASSSESSMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:480-510-3075
Mailing Address - Street 1:5732 W SHANNON ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1859
Mailing Address - Country:US
Mailing Address - Phone:480-510-3075
Mailing Address - Fax:480-940-1082
Practice Address - Street 1:5732 W SHANNON ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1859
Practice Address - Country:US
Practice Address - Phone:480-510-3075
Practice Address - Fax:480-940-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 053217261QC1800X, 261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Not Answered261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ162308OtherAHCCCS PROVIDER NUMBER