Organization
FOOTHILLS SPORTS MEDICINE & REHABILITATION - SEVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BASTEN (OWNER)
(480) 689-5515
Entity
Organization
Contact information
Practice address
3336 E CHANDLER HEIGHTS RD, SUITE 5-126, GILBERT, AZ 85297-4259
(480) 840-6125
(480) 840-6122
Mailing address
15410 S MOUNTAIN PKWY, SUITE 112, PHOENIX, AZ 85044-6691
(480) 689-5509
(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
08/20/2006
Last updated
05/05/2022
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