Provider Demographics
NPI:1558710152
Name:PHYSICAL MEDICINE OF SCOTTSDALE, LLC
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE OF SCOTTSDALE, LLC
Other - Org Name:ARIZONA PAIN RELIEF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-760-5896
Mailing Address - Street 1:10605 N HAYDEN RD
Mailing Address - Street 2:SUITE G110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5686
Mailing Address - Country:US
Mailing Address - Phone:480-443-2584
Mailing Address - Fax:
Practice Address - Street 1:10605 N HAYDEN RD
Practice Address - Street 2:SUITE G110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5686
Practice Address - Country:US
Practice Address - Phone:623-551-9950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9056207R00000X, 208D00000X
208VP0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty