Organization
FOOTHILLS SPORTS MEDICINE & REHABILITATION - GOLD CANYON, LLC
Active
Organization
FOOTHILLS SPORTS MEDICINE & REHABILITATION - GOLD CANYON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BASTEN (OWNER)
(480) 689-5515
Entity
Organization
Contact information
Practice address
6788 S KINGS RANCH RD, STE 4, GOLD CANYON, AZ 85118-2931
(480) 982-1909
Mailing address
15410 S MOUNTAIN PKWY, SUITE 112, PHOENIX, AZ 85044-6691
(480) 706-1161
(480) 706-7997
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Enumeration date
01/24/2014
Last updated
05/04/2016
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