Organization
LOOK, SEE, MOVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHAEDRA ANTIOCO OTR/L (OWNER)
(520) 401-1081
Entity
Organization
Contact information
Practice address
1801 S JENTILLY LN, SUITE A4, TEMPE, AZ 85281-5758
(520) 401-1081
Mailing address
3801 E PARK AVE, PHOENIX, AZ 85044-8255
(520) 401-1081
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
2668
AZ
Other
Enumeration date
09/28/2010
Last updated
09/28/2010
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