MEDICARE: MUSTARD SEEDS THERAPIES AZ LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1447114392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSTARD SEEDS THERAPIES AZ LLC

Provider Business Mailing Address
First Line	:	9898 SCOTTISH GLEN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-3854
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4539 N 22ND ST STE R
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4639
Country	:	US
Telephone Number	:	786-746-9079
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS BOWEN
Credential	:	COTA/L
Telephone Number	:	786-746-9079

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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