Provider Demographics
NPI:1952331142
Name:SCOTTSDALE PHYSICAL MEDICINE & REHABILITATION
Entity Type:Organization
Organization Name:SCOTTSDALE PHYSICAL MEDICINE & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-947-7711
Mailing Address - Street 1:7301 E 2ND ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5600
Mailing Address - Country:US
Mailing Address - Phone:480-947-7711
Mailing Address - Fax:480-994-8530
Practice Address - Street 1:7301 E 2ND ST
Practice Address - Street 2:SUITE 315
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5600
Practice Address - Country:US
Practice Address - Phone:480-947-7711
Practice Address - Fax:480-994-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWDBZSMedicare ID - Type Unspecified