Provider Demographics
NPI:1932273109
Name:FUSION REHABILITATION PLLC
Entity Type:Organization
Organization Name:FUSION REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:SCHIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-569-5656
Mailing Address - Street 1:2418 E DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2425
Mailing Address - Country:US
Mailing Address - Phone:602-569-5656
Mailing Address - Fax:602-569-6119
Practice Address - Street 1:2418 E DANBURY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2425
Practice Address - Country:US
Practice Address - Phone:602-569-5656
Practice Address - Fax:602-569-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5893111N00000X
AZ5435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX ID NUMBER