Healthcare Provider Details

I. General information

NPI: 1235554478
Provider Name (Legal Business Name): JENNY LANDSBERG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18555 N 79TH AVE STE E101
GLENDALE AZ
85308-8392
US

IV. Provider business mailing address

18555 N 79TH AVE STE E101
GLENDALE AZ
85308-8392
US

V. Phone/Fax

Practice location:
  • Phone: 623-487-0947
  • Fax: 623-487-4897
Mailing address:
  • Phone: 623-487-0947
  • Fax: 623-487-4897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNY LANDSBERG
Title or Position: OWNER
Credential:
Phone: 623-487-0947