Healthcare Provider Details

I. General information

NPI: 1194808600
Provider Name (Legal Business Name): WHITE TANKS PHYSICAL THERAPY AND ORTHOPEDIC REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N LITCHFIELD RD SUITE 155
GOODYEAR AZ
85338-1333
US

IV. Provider business mailing address

250 N LITCHFIELD RD SUITE 155
GOODYEAR AZ
85338-1333
US

V. Phone/Fax

Practice location:
  • Phone: 623-882-9787
  • Fax:
Mailing address:
  • Phone: 623-882-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. PABLO RUIZ JR.
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: P.T.
Phone: 623-882-9787