Individual
MR. MIKE DANNY FAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE PHS HOSPITAL, FORT DEFIANCE, AZ 86504
(928) 729-8805
(928) 729-8814
Mailing address
402 ZORENA AVE, GALLUP, NM 87301-5688
(928) 729-8805
(928) 729-8814
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4295021
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000T5129
—
NM
05
—
779803
—
AZ
Enumeration date
10/25/2006
Last updated
07/08/2007
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