Organization
FOOTHILLS SPORTS MEDICINE & REHABILITATION -JCC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BASTEN (OWNER)
(480) 689-5515
Entity
Organization
Contact information
Practice address
3225 N CIVIC CENTER PLZ, SUITE 10, SCOTTSDALE, AZ 85251-6919
(480) 483-7121
Mailing address
15410 S MOUNTAIN PKWY, SUITE 112, PHOENIX, AZ 85044-6691
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
11/22/2011
Last updated
06/09/2015
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