Organization
FOOTHILLS SPORTS MEDICINE & REHABILITATION - SUN CITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BASTEN (OWNER)
(480) 689-5515
Entity
Organization
Contact information
Practice address
13933 W GRAND AVE, SUITE 301, SURPRISE, AZ 85374-2435
(623) 474-3952
Mailing address
4715 N 32ND ST, SUITE 108, PHOENIX, AZ 85018-3300
(480) 689-5520
(480) 706-7409
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Enumeration date
01/24/2014
Last updated
01/24/2014
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