Organization
SOUTH MOUNTAIN REHABILITATION P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER VINCENT PAKULIS D.C.,P.T. (PRESIDENT)
(480) 759-1082
Entity
Organization
Contact information
Practice address
4804 E CHANDLER BLVD, 106, PHOENIX, AZ 85048-0857
(480) 893-6020
(480) 785-5161
Mailing address
16016 S 45TH PL, PHOENIX, AZ 85048-7635
(480) 759-1082
(480) 785-5161
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5302
AZ
225100000X
Physical Therapist
2853
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AZ0241550
BCBS CHIROPRACTIC #
AZ
01
—
AZ0295410
BCBS PHYSICAL THERAPY #
AZ
Enumeration date
01/05/2007
Last updated
01/03/2008
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