Healthcare Provider Details

I. General information

NPI: 1902461312
Provider Name (Legal Business Name): MIGHTY OAKS THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20329 N 59TH AVE STE A5
GLENDALE AZ
85308-6854
US

IV. Provider business mailing address

26907 N 51ST DR
PHOENIX AZ
85083-1279
US

V. Phone/Fax

Practice location:
  • Phone: 630-956-1080
  • Fax:
Mailing address:
  • Phone: 630-956-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH ANNE RAKOZY
Title or Position: OWNER/THERAPIST
Credential: SLP
Phone: 630-956-1080