Basic Information
| Provider Information | |||||||||
| NPI: | 1285676569 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAIJ, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OPT REHAB CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10325 E RIGGS RD | ||||||||
| Address2: | #102 | ||||||||
| City: | SUN LAKES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852487623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808027081 | ||||||||
| FaxNumber: | 4808028492 | ||||||||
| Practice Location | |||||||||
| Address1: | 10325 E RIGGS RD | ||||||||
| Address2: | #102 | ||||||||
| City: | SUN LAKES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852487623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808027081 | ||||||||
| FaxNumber: | 4808029492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 07/01/2013 | ||||||||
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| AuthorizedOfficialLastName: | DURKA | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4808027081 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | OTC3123 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.