Basic Information
| Provider Information | |||||||||
| NPI: | 1235405093 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLAMAND | ||||||||
| FirstName: | JANELL | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 W WICKENBURG WAY STE 3 | ||||||||
| Address2: | |||||||||
| City: | WICKENBURG | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853902262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286680108 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1175 W WICKENBURG WAY STE 3 | ||||||||
| Address2: | |||||||||
| City: | WICKENBURG | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853902262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286680108 | ||||||||
| FaxNumber: | 9286680110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2012 | ||||||||
| LastUpdateDate: | 08/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3331 | NV | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 9489 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | P01623027 | 01 | AZ | RAILROAD MEDICARE | OTHER | Z186361 | 01 | AZ | MEDICARE | OTHER | 104798 | 05 | AZ | MEDICAID |