Organization
FOOTHILLS SPORTS MEDICINE PHYSICAL THERAPY- BUCKEYE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL L BASTEN DPT (DELEGATED OFFICIAL/CEO)
(480) 689-5515
Entity
Organization
Contact information
Practice address
1300 S WATSON RD STE 104, BUCKEYE, AZ 85326-6264
(480) 706-1161
Mailing address
15410 S MOUNTAIN PKWY STE 112, PHOENIX, AZ 85044-6691
(480) 689-5534
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
03/14/2022
Last updated
03/25/2022
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