# SEDONA INTEGRATIVE MEDICAL CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932349867
- **Authorized official:** NICOL MARIE MOODY (OFFICE MANAGER)
- **Authorized official phone:** (928) 284-0166

## Contact information

- **Practice address:** 450 S WILLARD ST STE 101, COTTONWOOD, AZ 86326-6744
- **Practice address phone:** (928) 284-0166
- **Practice address fax:** (928) 284-1810
- **Mailing address:** 450 S WILLARD ST STE 101, COTTONWOOD, AZ 86326-6744
- **Mailing address phone:** (928) 284-0166
- **Mailing address fax:** (928) 284-1810

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 225100000X | Physical Therapist | 5669 | AZ | — |

## Other

- **Enumeration date:** 03/05/2009
- **Last updated:** 07/18/2022