1316970437 NPI number — VITALITY PHYSICAL THERAPY AND WELLNESS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316970437 NPI number — VITALITY PHYSICAL THERAPY AND WELLNESS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITALITY PHYSICAL THERAPY AND WELLNESS, INC
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:
Provider Other Organization Name Type Code:
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:
1316970437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4632 S CALICO RD
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:
85297-9587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-329-7447
Provider Business Mailing Address Fax Number:
480-636-7880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6804 S KINGS RANCH RD
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
GOLD CANYON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85118-2960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-983-8600
Provider Business Practice Location Address Fax Number:
480-983-8601
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALBARIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ZARSADIAZ
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-329-7447

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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