Healthcare Provider Details

I. General information

NPI: 1316464795
Provider Name (Legal Business Name): AMY GRULKE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2248 N ALMA SCHOOL RD STE 102
CHANDLER AZ
85224-2488
US

IV. Provider business mailing address

2322 W STOTTLER DR
CHANDLER AZ
85224-2524
US

V. Phone/Fax

Practice location:
  • Phone: 480-935-0614
  • Fax: 480-393-1968
Mailing address:
  • Phone: 480-935-0614
  • Fax: 480-393-1968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5749
License Number StateAZ

VIII. Authorized Official

Name: MRS. AMY GRULKE
Title or Position: OWNER
Credential: MS, CCC-SLP
Phone: 480-935-0614