Provider Demographics
NPI:1881648673
Name:FOLEY, WAYNE R (PT)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:R
Last Name:FOLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 S KINGS RANCH RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-2960
Mailing Address - Country:US
Mailing Address - Phone:480-982-1909
Mailing Address - Fax:480-982-3002
Practice Address - Street 1:6804 S KINGS RANCH RD STE 103
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-2960
Practice Address - Country:US
Practice Address - Phone:480-982-1909
Practice Address - Fax:480-982-3002
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ201569Medicaid
AZ103323Medicare ID - Type Unspecified
AZ120770Medicare PIN