Healthcare Provider Details

I. General information

NPI: 1730271875
Provider Name (Legal Business Name): ANGELS TOUCH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11570 E CORNVILLE RD
CORNVILLE AZ
86325-5243
US

IV. Provider business mailing address

11570 E CORNVILLE RD
CORNVILLE AZ
86325-5243
US

V. Phone/Fax

Practice location:
  • Phone: 928-634-0665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4060
License Number StateAZ

VIII. Authorized Official

Name: ANTOINETTE MUNOZ
Title or Position: DIRECTOR
Credential: PT
Phone: 928-634-0665