MEDICARE: BRANSON PHYSICAL THERAPY A ARIZONA 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	261QP2000X	Physical Therapy Clinic/Center	3316	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	859613	OTHER	AZ	OPTUM
2	16798522859	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1679852289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANSON PHYSICAL THERAPY A ARIZONA LLC

Provider Business Mailing Address
First Line	:	850 S IRONWOOD DR
Second Line	:	SUITE 112
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85120-6242
Country	:	US
Telephone Number	:	480-983-1680
Fax Number	:	480-983-1681

Provider Business Practice Location Address
First Line	:	850 S IRONWOOD DR
Second Line	:	SUITE 112
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85120-6242
Country	:	US
Telephone Number	:	480-983-1680
Fax Number	:	480-983-1681

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MR. GARRY W BRANSON
Credential	:	DPT
Telephone Number	:	480-983-1680

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	11/06/2023

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Directions to “BRANSON PHYSICAL THERAPY A ARIZONA LLC ” Practice Location

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