Healthcare Provider Details

I. General information

NPI: 1710181748
Provider Name (Legal Business Name): GENERATIONS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E WILLIAMS FIELD RD SUITE 200
GILBERT AZ
85295-0761
US

IV. Provider business mailing address

4960 S GILBERT RD SUITE 1-496
CHANDLER AZ
85249-5982
US

V. Phone/Fax

Practice location:
  • Phone: 480-320-2304
  • Fax: 888-243-7186
Mailing address:
  • Phone: 480-917-2745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5580
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP5625
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP0332
License Number StateAZ

VIII. Authorized Official

Name: DR. ANGELA MARIE HALLUMS
Title or Position: CEO
Credential: D.P.T.
Phone: 480-206-4264