Provider Demographics
NPI:1760995294
Name:SW PHYSICAL MEDICINE AND REHABILITATION, PLLC
Entity Type:Organization
Organization Name:SW PHYSICAL MEDICINE AND REHABILITATION, PLLC
Other - Org Name:REBECCA T. ARMENDARIZ, MD, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:ARMENDARIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-386-9181
Mailing Address - Street 1:65 VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5503
Mailing Address - Country:US
Mailing Address - Phone:804-386-9181
Mailing Address - Fax:
Practice Address - Street 1:2650 N WYATT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6106
Practice Address - Country:US
Practice Address - Phone:520-325-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47934208100000X, 2081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12172540OtherCAQH NUMBER
AZ835234Medicaid
1073773818OtherINDIV NPI #
AZ1760995294OtherNPI TYPE 2