Healthcare Provider Details

I. General information

NPI: 1679852289
Provider Name (Legal Business Name): BRANSON PHYSICAL THERAPY A ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S IRONWOOD DR SUITE 112
APACHE JUNCTION AZ
85120-6242
US

IV. Provider business mailing address

850 S IRONWOOD DR SUITE 112
APACHE JUNCTION AZ
85120-6242
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-1680
  • Fax: 480-983-1681
Mailing address:
  • Phone: 480-983-1680
  • Fax: 480-983-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number3316
License Number StateAZ

VIII. Authorized Official

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