Organization
FOOTHILLS SPORTS MEDICINE & PHYSICAL THERAPY - 91ST AVE-OLIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BASTEN (OWNER)
(480) 689-5515
Entity
Organization
Contact information
Practice address
9069 W OLIVE AVE STE 105, PEORIA, AZ 85345-9124
(480) 706-1161
Mailing address
15410 S MOUNTAIN PKWY STE 112, PHOENIX, AZ 85044-6691
(480) 706-1161
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
03/11/2020
Last updated
07/18/2022
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