Provider Demographics
NPI:1104632439
Name:LITZ, IMANI NNU
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:NNU
Last Name:LITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 S LAKESHORE DR APT 2049
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1149
Mailing Address - Country:US
Mailing Address - Phone:520-990-2800
Mailing Address - Fax:
Practice Address - Street 1:4210 E BASELINE RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4418
Practice Address - Country:US
Practice Address - Phone:480-503-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist