Provider Demographics
NPI:1437416146
Name:PRO SPORTS PERFORMANCE & REHAB
Entity type:Organization
Organization Name:PRO SPORTS PERFORMANCE & REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MEINERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-433-4760
Mailing Address - Street 1:8630 E VIA DE VENTURA
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3326
Mailing Address - Country:US
Mailing Address - Phone:480-433-4760
Mailing Address - Fax:
Practice Address - Street 1:8630 E VIA DE VENTURA
Practice Address - Street 2:SUITE #101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3326
Practice Address - Country:US
Practice Address - Phone:480-433-4760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ73692251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty