Healthcare Provider Details

I. General information

NPI: 1639203995
Provider Name (Legal Business Name): MWR PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 S POWER RD BLDG 3 STE 112
GILBERT AZ
85297-9282
US

IV. Provider business mailing address

7400 S POWER RD BLDG 3 STE 112
GILBERT AZ
85297-9282
US

V. Phone/Fax

Practice location:
  • Phone: 480-682-5460
  • Fax: 480-682-5465
Mailing address:
  • Phone: 480-682-5460
  • Fax: 480-682-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5220
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7101A
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0080
License Number StateAZ

VIII. Authorized Official

Name: JAIME LINDLEY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 480-980-6288