Provider Demographics
NPI:1821109356
Name:ORTHOPEDIC & SPORT REHAB SPECIALISTS AT ANTHEM, LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPORT REHAB SPECIALISTS AT ANTHEM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:623-551-9706
Mailing Address - Street 1:41125 N DAISY MOUNTAIN DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-4956
Mailing Address - Country:US
Mailing Address - Phone:623-551-9706
Mailing Address - Fax:623-551-5078
Practice Address - Street 1:41125 N DAISY MOUNTAIN DR
Practice Address - Street 2:SUITE 121
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-4956
Practice Address - Country:US
Practice Address - Phone:623-551-9706
Practice Address - Fax:623-551-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG5841OtherMERCY HEALTHCARE GROUP#
AZ111737OtherHEALTH PARTNERS GROUP#
AZAZ0460610OtherBCBS AZ GROUP#
AZZ13579OtherHEALTHNET GROUP#
AZG5841OtherMERCY HEALTHCARE GROUP#