Provider Demographics
NPI:1962756411
Name:ARIZONA HAND AND PHYSICAL REHAB LLC
Entity type:Organization
Organization Name:ARIZONA HAND AND PHYSICAL REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMIHAS
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:928-777-9890
Mailing Address - Street 1:3111 CLEARWATER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7186
Mailing Address - Country:US
Mailing Address - Phone:928-777-9890
Mailing Address - Fax:928-777-9891
Practice Address - Street 1:3111 CLEARWATER DR
Practice Address - Street 2:SUITE C
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7186
Practice Address - Country:US
Practice Address - Phone:928-777-9890
Practice Address - Fax:928-777-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ957582Medicaid
AZ957582Medicaid
AZ6150690001Medicare NSC