1063701860 NPI number — HEALTHGAPS, LLC

Table of content: (NPI 1063701860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063701860 NPI number — HEALTHGAPS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHGAPS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRECISION MUSCLE RECOVERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063701860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2670 S. VOYAGER DR., SUITE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85295-1294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4111 EAST VALLEY AUTO DRIVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-4605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-369-0823
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
BRENDON
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT/MEMBER
Authorized Official Telephone Number:
602-369-0823

Provider Taxonomy Codes

  • Taxonomy code: 172M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)