Provider Demographics
NPI:1013798461
Name:LIFEQUEST PHYSICAL MEDICINE AND REHAB
Entity Type:Organization
Organization Name:LIFEQUEST PHYSICAL MEDICINE AND REHAB
Other - Org Name:QC COMBS 3, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-659-2000
Mailing Address - Street 1:37584 N GANTZEL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7547
Mailing Address - Country:US
Mailing Address - Phone:480-257-3157
Mailing Address - Fax:
Practice Address - Street 1:37584 N GANTZEL RD STE 105
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85140-7547
Practice Address - Country:US
Practice Address - Phone:480-257-3157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty