Basic Information
| Provider Information | |||||||||
| NPI: | 1801840897 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WING NEUROLOGICAL REHABILITATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1190 E MISSOURI AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850142734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023930520 | ||||||||
| FaxNumber: | 6023930523 | ||||||||
| Practice Location | |||||||||
| Address1: | 1190 E MISSOURI AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850142734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023930520 | ||||||||
| FaxNumber: | 6023930523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 10/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | WING | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | KATHERINE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6023930520 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 225200000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.