Provider Demographics
NPI:1457304792
Name:FOOTHILLS SPORTS MEDICINE & ORTHOPAEDICS PHOENIX, LLC
Entity Type:Organization
Organization Name:FOOTHILLS SPORTS MEDICINE & ORTHOPAEDICS PHOENIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANJA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SNOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-241-3145
Mailing Address - Street 1:539 E GLENDALE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4900
Mailing Address - Country:US
Mailing Address - Phone:602-241-3145
Mailing Address - Fax:
Practice Address - Street 1:539 E GLENDALE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4900
Practice Address - Country:US
Practice Address - Phone:602-241-3145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ79692Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER