Provider Demographics
NPI:1457403602
Name:METRO PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:METRO PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BASTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-689-5515
Mailing Address - Street 1:10000 N 31ST AVE #A102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9568
Mailing Address - Country:US
Mailing Address - Phone:602-866-0066
Mailing Address - Fax:602-866-3868
Practice Address - Street 1:11225 N 28TH DR STE F100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5606
Practice Address - Country:US
Practice Address - Phone:602-866-0066
Practice Address - Fax:602-866-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ60423Medicare PIN