Healthcare Provider Details

I. General information

NPI: 1366874141
Provider Name (Legal Business Name): MARGARET RAVENNA KLAUSING PT, DPT, MSCI, CCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 03/28/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 W UTOPIA RD
GLENDALE AZ
85308-5229
US

IV. Provider business mailing address

19389 N 59TH AVE
GLENDALE AZ
85308-6500
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-6000
  • Fax: 623-537-6014
Mailing address:
  • Phone: 623-537-6600
  • Fax: 623-537-6014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9867
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: