Individual
MICHAEL BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
520 ROSE LN, WICKENBURG, AZ 85390-1447
(928) 684-5529
(928) 684-8717
Mailing address
520 ROSE LN, WICKENBURG, AZ 85390-1447
(928) 684-5529
(928) 684-8717
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11640
AZ
Other
Enumeration date
03/09/2017
Last updated
03/09/2017
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