Organization
SVASSAMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC D BRUMMEL P.T. (OWNER)
(928) 445-5639
Entity
Organization
Contact information
Practice address
3101 CLEARWATER DR, SUITE D, PRESCOTT, AZ 86305-7180
(928) 445-5639
(928) 442-0031
Mailing address
PO BOX 13159, PRESCOTT, AZ 86304-3159
(928) 445-5639
(928) 442-0031
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
3833
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
554239
—
AZ
01
—
AZ0463420
BCBS
AZ
Enumeration date
07/09/2008
Last updated
07/09/2008
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