MEDICARE: SOUTH MOUNTAIN 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	:	1528406113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH MOUNTAIN PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	3230 E BASELINE RD STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 E BASELINE RD STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7133
Country	:	US
Telephone Number	:	602-438-9773
Fax Number	:	602-438-9776

Authorized Official
Title or Position	:	MEMBER
Name	:	EVA ORSO
Credential	:
Telephone Number	:	480-747-0828

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	06/05/2013

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