Provider Demographics
NPI:1598945768
Name:CONCENTRA MEDICAL CENTER
Entity Type:Organization
Organization Name:CONCENTRA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-244-9500
Mailing Address - Street 1:1818 E SKY HARBOR CIR N
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-3407
Mailing Address - Country:US
Mailing Address - Phone:602-244-9500
Mailing Address - Fax:602-914-9159
Practice Address - Street 1:1818 E SKY HARBOR CIR N
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-3407
Practice Address - Country:US
Practice Address - Phone:602-244-9500
Practice Address - Fax:602-914-9159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD05865502261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy