Provider Demographics
NPI:1508819228
Name:VALLEY PHYSICAL MEDICINE & REHABILITATION, P C
Entity Type:Organization
Organization Name:VALLEY PHYSICAL MEDICINE & REHABILITATION, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRANKS-MITCHELL JAUREGUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-406-4578
Mailing Address - Street 1:222 W THOMAS RD
Mailing Address - Street 2:STE 114
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013
Mailing Address - Country:US
Mailing Address - Phone:602-406-6304
Mailing Address - Fax:602-406-6302
Practice Address - Street 1:222 W THOMAS RD STE 114
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4420
Practice Address - Country:US
Practice Address - Phone:602-406-4578
Practice Address - Fax:602-406-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ66051OtherMEDICARE PTAN
AZZ66051OtherMEDICARE PTAN