Provider Demographics
NPI:1558685412
Name:COMPREHENSIVE PHYSICAL MEDICINE AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE PHYSICAL MEDICINE AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSPACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-780-3751
Mailing Address - Street 1:PO BOX 9907
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-0907
Mailing Address - Country:US
Mailing Address - Phone:623-780-3751
Mailing Address - Fax:623-780-3752
Practice Address - Street 1:9250 N 3RD ST
Practice Address - Street 2:SUITE 2007
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2437
Practice Address - Country:US
Practice Address - Phone:623-780-3751
Practice Address - Fax:623-780-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty