MEDICARE: LONE TREE PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1174505812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE TREE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	1596 SUSAN A WILLIAMS WAY
Second Line	:	SUITE D
City	:	CHINO VALLEY
State	:	AZ
Zip	:	86323-6172
Country	:	US
Telephone Number	:	928-636-7950
Fax Number	:	928-636-7951

Provider Business Practice Location Address
First Line	:	1596 SUSAN A WILLIAMS WAY
Second Line	:	SUITE D
City	:	CHINO VALLEY
State	:	AZ
Zip	:	86323-6172
Country	:	US
Telephone Number	:	928-636-7950
Fax Number	:	928-636-7951

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. NICHOLE LEI BOY
Credential	:	PT, ATC
Telephone Number	:	928-636-7950

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	08/22/2020

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