1689627630 NPI number — MRS. MICHELLE MARIE BABCOCK PT MSPT

Table of content: MRS. MICHELLE MARIE BABCOCK PT MSPT (NPI 1689627630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689627630 NPI number — MRS. MICHELLE MARIE BABCOCK PT MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BABCOCK
Provider First Name:
MICHELLE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEMENEZES
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT MSPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689627630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9097 E DESERT COVE
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-860-4298
Provider Business Mailing Address Fax Number:
480-860-0356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16611 S 40TH ST
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85048-0562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-706-1199
Provider Business Practice Location Address Fax Number:
480-706-3999
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5937 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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