Healthcare Provider Details

I. General information

NPI: 1609237635
Provider Name (Legal Business Name): DESERT DOLPHIN AQUATIC THERAPY & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 S COLE DR
GILBERT AZ
85295
US

IV. Provider business mailing address

1903 S COLE DR
GILBERT AZ
85295
US

V. Phone/Fax

Practice location:
  • Phone: 480-760-3458
  • Fax:
Mailing address:
  • Phone: 480-760-3458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BONNIE SANTOS
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PHYSICAL THERAPIST
Phone: 480-760-3458