Provider Demographics
NPI:1174932891
Name:WOMEN'S CENTER FOR WELLNESS AND REHABILIATION
Entity type:Organization
Organization Name:WOMEN'S CENTER FOR WELLNESS AND REHABILIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-264-3369
Mailing Address - Street 1:4545 E SHEA BLVD
Mailing Address - Street 2:SUITE 168
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3074
Mailing Address - Country:US
Mailing Address - Phone:602-264-3369
Mailing Address - Fax:
Practice Address - Street 1:4545 E SHEA BLVD
Practice Address - Street 2:SUITE 168
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3074
Practice Address - Country:US
Practice Address - Phone:602-264-3369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13-1365175F00000X
AZ2817225100000X
AZ6451225100000X
AZ10027225100000X
AZ7003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Single Specialty