Healthcare Provider Details

I. General information

NPI: 1851859664
Provider Name (Legal Business Name): DISTINCT PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W CHANDLER BLVD STE A-4
CHANDLER AZ
85225-4908
US

IV. Provider business mailing address

900 W CHANDLER BLVD STE A-4
CHANDLER AZ
85225-4908
US

V. Phone/Fax

Practice location:
  • Phone: 480-887-8725
  • Fax: 480-719-1531
Mailing address:
  • Phone: 480-887-8725
  • Fax: 480-719-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN A LEWIS
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 480-887-8725