Organization
ORTHOMED LLC
Active
Other names
Proactive Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL L BASTEN DPT (OWNER)
(480) 706-1161
Entity
Organization
Contact information
Practice address
15410 S MOUNTAIN PKWY STE 112, PHOENIX, AZ 85044-6691
(480) 706-1161
(480) 706-7997
Mailing address
15410 S MOUNTAIN PKWY STE 112, PHOENIX, AZ 85044-6691
(480) 706-1116
(480) 706-7997
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
—
—
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
07/14/2006
Last updated
07/13/2021
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