Individual
THEDA BROTHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FP
Contact information
Practice address
6211 S 21ST ST, PHOENIX, AZ 85042-4645
(602) 276-5894
Mailing address
6211 S 21ST ST, PHOENIX, AZ 85042-4645
(602) 276-5894
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/21/2008
Last updated
05/21/2008
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