Provider Demographics
NPI:1639386337
Name:REHAB ARIZONA PHYSICAL AND HAND REHABILITION
Entity Type:Organization
Organization Name:REHAB ARIZONA PHYSICAL AND HAND REHABILITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINTYA
Authorized Official - Middle Name:MARCELLA
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-649-3111
Mailing Address - Street 1:303 N CENTENNIAL WAY
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6733
Mailing Address - Country:US
Mailing Address - Phone:480-649-3111
Mailing Address - Fax:480-649-3113
Practice Address - Street 1:303 N CENTENNIAL WAY
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6733
Practice Address - Country:US
Practice Address - Phone:480-649-3111
Practice Address - Fax:480-649-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2478174400000X
AZ5385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ153977OtherAHCCS
AZAZ0463540OtherBCBS ID NUMBER
AZ2Z2223OtherHEALTHNET
AZAZ0463540OtherBCBS ID NUMBER