Basic Information
| Provider Information | |||||||||
| NPI: | 1760995294 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SW PHYSICAL MEDICINE AND REHABILITATION, PLLC | ||||||||
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| OtherOrganizationName: | REBECCA T. ARMENDARIZ, MD, PLLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 VIEW DR | ||||||||
| Address2: | |||||||||
| City: | SEDONA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863365503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043869181 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2650 N WYATT DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857126106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203251300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2017 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | ARMENDARIZ | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | TERESA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8043869181 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081H0002X | 47934 | AZ | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Hospice and Palliative Medicine | 208100000X | 47934 | AZ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 12172540 | 01 | CAQH NUMBER | OTHER | 835234 | 05 | AZ | MEDICAID | 1073773818 | 01 | INDIV NPI # | OTHER | 1760995294 | 01 | AZ | NPI TYPE 2 | OTHER |