Basic Information
| Provider Information | |||||||||
| NPI: | 1699405050 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOOTHILLS SPORTS MEDICINE AND REHABILITATION, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15410 S MOUNTAIN PKWY | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850446691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809408299 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3305 N SWAN RD STE 115 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857121273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207446445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2022 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | BINDER | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR REVENUE CYCLE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4804104727 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.