Provider Demographics
NPI:1871533125
Name:CONTACT PHYSICAL THERAPY SCOTTSDALE
Entity type:Organization
Organization Name:CONTACT PHYSICAL THERAPY SCOTTSDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSERBECK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-396-2781
Mailing Address - Street 1:4850 E BASELINE RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4625
Mailing Address - Country:US
Mailing Address - Phone:480-396-2781
Mailing Address - Fax:480-854-3094
Practice Address - Street 1:10304 N HAYDEN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1217
Practice Address - Country:US
Practice Address - Phone:480-429-5266
Practice Address - Fax:480-429-5297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6323480001Medicare NSC
AZZ115116Medicare PIN