Provider Demographics
NPI:1942250196
Name:METRO PHYSICAL THERAPY OF SCOTTSDALE
Entity Type:Organization
Organization Name:METRO PHYSICAL THERAPY OF SCOTTSDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-614-5878
Mailing Address - Street 1:9332 N 95TH WAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5536
Mailing Address - Country:US
Mailing Address - Phone:480-614-5878
Mailing Address - Fax:480-614-5860
Practice Address - Street 1:9332 N 95TH WAY
Practice Address - Street 2:SUITE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5536
Practice Address - Country:US
Practice Address - Phone:480-614-5878
Practice Address - Fax:480-614-5860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-03-21
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
AZZ109738Medicare PIN