Healthcare Provider Details

I. General information

NPI: 1720022346
Provider Name (Legal Business Name): SKYLINE PHYSICAL THERAPY AQUATICS AND REHAB SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10241 E APACHE TRL
APACHE JUNCTION AZ
85120-3203
US

IV. Provider business mailing address

PO BOX 3497
STURTEVANT WI
53177-0300
US

V. Phone/Fax

Practice location:
  • Phone: 877-474-3424
  • Fax: 480-984-5750
Mailing address:
  • Phone: 877-552-2996
  • Fax: 866-245-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LARRY D BRIAND
Title or Position: CO-OWNER
Credential: MS, PT, ATC
Phone: 877-552-2996