Healthcare Provider Details

I. General information

NPI: 1407952435
Provider Name (Legal Business Name): JONATHAN ROBERT PAULY M.P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 W SARAGOSA PL
CHANDLER AZ
85224-7216
US

IV. Provider business mailing address

PO BOX 6854
CHANDLER AZ
85246-6854
US

V. Phone/Fax

Practice location:
  • Phone: 480-250-4741
  • Fax: 480-840-1404
Mailing address:
  • Phone: 480-250-4741
  • Fax: 480-840-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5440
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5440
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2251H1300X
TaxonomyHuman Factors Physical Therapist
License Number5440
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number5440
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5440
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: