Healthcare Provider Details

I. General information

NPI: 1669230934
Provider Name (Legal Business Name): BENJAMIN GALAVIZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 N DYSART RD STE 109
AVONDALE AZ
85392-6802
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 623-522-8491
  • Fax:
Mailing address:
  • Phone: 630-575-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number033499
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: