Provider Demographics
NPI:1265708317
Name:GILBERT PHYSICAL MEDICINE LLC
Entity type:Organization
Organization Name:GILBERT PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-545-0000
Mailing Address - Street 1:725 W ELLIOT RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5301
Mailing Address - Country:US
Mailing Address - Phone:480-545-0000
Mailing Address - Fax:480-545-7615
Practice Address - Street 1:725 W ELLIOT RD
Practice Address - Street 2:SUITE 115
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5301
Practice Address - Country:US
Practice Address - Phone:480-545-0000
Practice Address - Fax:480-545-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty