Provider Demographics
NPI:1336612993
Name:PHYSICAL MEDICINE OF GILBERT LLC
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE OF GILBERT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-441-3573
Mailing Address - Street 1:130 S VAL VISTA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1363
Mailing Address - Country:US
Mailing Address - Phone:480-912-1434
Mailing Address - Fax:480-887-8041
Practice Address - Street 1:130 S VAL VISTA DR STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1363
Practice Address - Country:US
Practice Address - Phone:602-441-3573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty