Provider Demographics
NPI:1316970437
Name:VITALITY PHYSICAL THERAPY AND WELLNESS, INC
Entity type:Organization
Organization Name:VITALITY PHYSICAL THERAPY AND WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ZARSADIAZ
Authorized Official - Last Name:BALBARIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-329-7447
Mailing Address - Street 1:4632 S CALICO RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-9587
Mailing Address - Country:US
Mailing Address - Phone:480-329-7447
Mailing Address - Fax:480-636-7880
Practice Address - Street 1:6804 S KINGS RANCH RD
Practice Address - Street 2:STE 103
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-2960
Practice Address - Country:US
Practice Address - Phone:480-983-8600
Practice Address - Fax:480-983-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ107768Medicare ID - Type Unspecified