Provider Demographics
NPI:1811628191
Name:SOUTHWEST SPORTS MEDICINE AND REHABILITATION LLC
Entity Type:Organization
Organization Name:SOUTHWEST SPORTS MEDICINE AND REHABILITATION LLC
Other - Org Name:FYZICAL THERAPY AND BALANCE CENTER PHOENIX MIDTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ATC
Authorized Official - Phone:602-606-9619
Mailing Address - Street 1:PO BOX 2253
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85002-2253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3330 N 2ND ST STE 401
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2371
Practice Address - Country:US
Practice Address - Phone:602-606-9619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-18
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty