Mike Danny Faz, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4295021 Issued in AZ

Practice address

Corner of Route N12 and N7
Fort Defiance PHS Hospital
Fort Defiance, AZ 86504

Phone

(928) 729-8805

Fax

(928) 729-8814

NPI assigned

Oct 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750466249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 ZORENA AVE",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015688",
            "telephone_number": "928-729-8805",
            "fax_number": "928-729-8814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CORNER OF ROUTE N12 AND N7",
            "address_2": "FORT DEFIANCE PHS HOSPITAL",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "86504",
            "telephone_number": "928-729-8805",
            "fax_number": "928-729-8814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZ",
        "first_name": "MIKE",
        "middle_name": "DANNY",
        "name_prefix": "Mr.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "4295021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000T5129",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "779803",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Francis Eucalitto, MD
• Faustina Niyemamwen Evbuomwan, B.SC PHARM
• Tessa Tahereh Facer, PA-C
• Perlita R Fajardo, RRT
• Brenda Farrish
• Amber Anne Fischer, PT, DPT
• David Allen Fleming, DDS
• Belinda Fomba
• Jamie Noel Fontaine
• Angela H. Fontenot, NP

• Physical Therapist in Fort Defiance, AZ
• Providers in Fort Defiance, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.