Healthcare Provider Details

I. General information

NPI: 1972958460
Provider Name (Legal Business Name): ABOVE & BEYOND MOBILE THERAPY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 E TREMAINE AVE
GILBERT AZ
85234-4623
US

IV. Provider business mailing address

413 E TREMAINE AVE
GILBERT AZ
85234-4623
US

V. Phone/Fax

Practice location:
  • Phone: 480-787-8777
  • Fax: 480-820-7339
Mailing address:
  • Phone: 480-787-8777
  • Fax: 480-820-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID MICHAEL KENT
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 480-787-8777