Individual
NIDA NAMATHEP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
6036 N 19TH AVE, PHOENIX, AZ 85015-2106
(602) 795-8441
(602) 795-8447
Mailing address
PO BOX 6570, PEORIA, AZ 85385-6570
(623) 398-8072
(623) 398-8235
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
11261A
AZ
Other
Enumeration date
01/04/2016
Last updated
01/04/2016
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