Provider Demographics
NPI:1578560900
Name:INSTITUTE FOR BONE & JOINT DISORDERS PC
Entity Type:Organization
Organization Name:INSTITUTE FOR BONE & JOINT DISORDERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRIKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOTWALA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:602-778-0900
Mailing Address - Street 1:PO BOX 52507
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-2507
Mailing Address - Country:US
Mailing Address - Phone:602-778-0900
Mailing Address - Fax:602-778-6606
Practice Address - Street 1:2222 E HIGHLAND AVE
Practice Address - Street 2:SUITE 130, 400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4872
Practice Address - Country:US
Practice Address - Phone:602-778-0900
Practice Address - Fax:602-778-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCHWMMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER