Michael Bacon, PT
Individual provider Active NPI Physical Therapist · Wickenburg, AZ
NPI 1851832885 · NPPES record last updated Mar 9, 2017
Key facts
- NPI
- 1851832885
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 11640 (AZ)
- Practice address
- 520 Rose LN
Wickenburg, AZ 85390-1447 - Phone
- (928) 684-5529
- Fax
- (928) 684-8717
- NPI assigned
- Mar 9, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11640 | AZ | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11640 | AZ | Yes |
Addresses
Primary practice location
520 Rose LN
Wickenburg, AZ 85390-1447
Mailing address
520 Rose LN
Wickenburg, AZ 85390-1447
Phone (928) 684-5529
Other providers in Wickenburg, AZ
- Applied Behavioral Interventions, PLLC
- Arizona CVS Stores, L.L.C.
- Arizona Em-1 Medical Services, PC
- Arizona Mental Health, PLLC
- Molly Atwood
- Stephanie Baker
- Dennis A Barraco
- Lea Bastin
- Diane Grace Bejerano
- Darrell Allan Benham
All providers in Wickenburg, AZ · Physical Therapist in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.