1366630592 NPI number — INTERWEST REHABILITATION - SCOTTSDALE, LLC

Table of content: (NPI 1366630592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366630592 NPI number — INTERWEST REHABILITATION - SCOTTSDALE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERWEST REHABILITATION - SCOTTSDALE, 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:
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:
1366630592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 N SCOTTSDALE RD
Provider Second Line Business Mailing Address:
STE. 120
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251-5648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-429-1771
Provider Business Mailing Address Fax Number:
480-429-2498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2960 N CIRCLE DR
Provider Second Line Business Practice Location Address:
STE. 125
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80909-1163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-634-7246
Provider Business Practice Location Address Fax Number:
719-634-4042
Provider Enumeration Date:
10/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAYWOOD
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
719-634-7246

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com