Provider Demographics
NPI:1255562625
Name:BISCONTINI, CARL M (PT,DPT,CSCS,CGFI)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:M
Last Name:BISCONTINI
Suffix:
Gender:M
Credentials:PT,DPT,CSCS,CGFI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 S SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-3079
Mailing Address - Country:US
Mailing Address - Phone:623-282-4009
Mailing Address - Fax:
Practice Address - Street 1:4108 S SAWMILL RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-3079
Practice Address - Country:US
Practice Address - Phone:623-282-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ85652251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036551Medicare UPIN