Healthcare Provider Details

I. General information

NPI: 1992825830
Provider Name (Legal Business Name): ARIZONA SERVICES FOR DEVELOPMENTAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E PAGE AVE
GILBERT AZ
85234-6212
US

IV. Provider business mailing address

2101 E PAGE AVE
GILBERT AZ
85234-6212
US

V. Phone/Fax

Practice location:
  • Phone: 480-926-1399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number0503
License Number StateAZ

VIII. Authorized Official

Name: ROXANNE SMALL
Title or Position: OWNER PHYSICAL THERAPIST
Credential: PT
Phone: 480-926-1399