Provider Demographics
NPI:1104076207
Name:MACE, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MACE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BELL ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-8600
Mailing Address - Country:US
Mailing Address - Phone:928-282-6775
Mailing Address - Fax:928-282-2349
Practice Address - Street 1:555 BELL ROCK BLVD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-8600
Practice Address - Country:US
Practice Address - Phone:928-282-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist