Healthcare Provider Details

I. General information

NPI: 1457805954
Provider Name (Legal Business Name): WESTERGARD PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 S PHEASANT DR
GILBERT AZ
85296-9699
US

IV. Provider business mailing address

1349 S PHEASANT DR
GILBERT AZ
85296-9699
US

V. Phone/Fax

Practice location:
  • Phone: 760-861-6892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. WILLIAM WESTERGARD
Title or Position: OWNER
Credential: PT, DPT
Phone: 760-861-6892