Provider Demographics
NPI:1154483170
Name:EXOS - ATHLETES PERFORMANCE ARIZONA LLC
Entity type:Organization
Organization Name:EXOS - ATHLETES PERFORMANCE ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PHYSICAL THERAPY
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:214-618-3246
Mailing Address - Street 1:2629 E ROSE GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4605
Mailing Address - Country:US
Mailing Address - Phone:480-449-9000
Mailing Address - Fax:480-449-9200
Practice Address - Street 1:2629 E ROSE GARDEN LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4605
Practice Address - Country:US
Practice Address - Phone:480-449-9000
Practice Address - Fax:480-449-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty