Healthcare Provider Details

I. General information

NPI: 1649353632
Provider Name (Legal Business Name): MICHAEL J. OSTLER MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 S VAL VISTA DR STE 171
GILBERT AZ
85295-1683
US

IV. Provider business mailing address

745 N GILBERT RD STE 124
GILBERT AZ
85234-4616
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-4200
  • Fax: 480-821-4447
Mailing address:
  • Phone: 760-591-7750
  • Fax: 760-410-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6404
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: