Organization
FOOTHILLS SPORTS MEDICINE & REHABILITATION - PRESCOTT VALLEY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BASTEN PT (OWNER)
(480) 689-5515
Entity
Organization
Contact information
Practice address
3033 N WINDSONG DR, SUITE 101, PRESCOTT VALLEY, AZ 86314-2290
(480) 706-1161
Mailing address
15410 S MOUNTAIN PKWY, SUITE 112, PHOENIX, AZ 85044-6691
(480) 706-1161
(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
08/01/2014
Last updated
08/15/2014
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