Provider Demographics
NPI:1801840897
Name:WING NEUROLOGICAL REHABILITATION
Entity Type:Organization
Organization Name:WING NEUROLOGICAL REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:WING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-393-0520
Mailing Address - Street 1:1190 E MISSOURI AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2734
Mailing Address - Country:US
Mailing Address - Phone:602-393-0520
Mailing Address - Fax:602-393-0523
Practice Address - Street 1:1190 E MISSOURI AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2734
Practice Address - Country:US
Practice Address - Phone:602-393-0520
Practice Address - Fax:602-393-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ76677Medicare PIN