Provider Demographics
NPI:1568720837
Name:STELLAR PHYSICAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:STELLAR PHYSICAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-423-3525
Mailing Address - Street 1:9301 E SHEA BLVD
Mailing Address - Street 2:STE. 118
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6733
Mailing Address - Country:US
Mailing Address - Phone:480-423-3525
Mailing Address - Fax:866-738-0810
Practice Address - Street 1:9301 E SHEA BLVD
Practice Address - Street 2:STE. 118
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6733
Practice Address - Country:US
Practice Address - Phone:480-423-3525
Practice Address - Fax:866-738-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34046208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1962573139OtherNPI
G16718Medicare UPIN