Organization
ADULT AND PEDIATRIC REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SERGIO IVAN MACIAS P.T. (OWNER)
(928) 722-6050
Entity
Organization
Contact information
Practice address
1453 N MAIN STREET, 7, SAN LUIS, AZ 85349
(928) 722-6050
(928) 722-6094
Mailing address
PO BOX 5841, YUMA, AZ 85366-2490
(928) 722-6050
(928) 722-6094
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4229
AZ
332B00000X
Durable Medical Equipment & Medical Supplies
C001071
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
729459
—
AZ
Enumeration date
08/13/2012
Last updated
04/01/2024
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