Provider Demographics
NPI:1356340228
Name:WASSERBECK, DAVID A (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:WASSERBECK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E JOSEPH WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-6408
Mailing Address - Country:US
Mailing Address - Phone:480-628-2284
Mailing Address - Fax:
Practice Address - Street 1:4850 E BASELINE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4625
Practice Address - Country:US
Practice Address - Phone:480-396-2781
Practice Address - Fax:480-854-3094
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ75737Medicare ID - Type Unspecified