Healthcare Provider Details

I. General information

NPI: 1528051059
Provider Name (Legal Business Name): SALLIGATORS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TILBURY RD.
KEARNY AZ
85237
US

IV. Provider business mailing address

41149 N COYOTE RD
QUEEN CREEK AZ
85242-9680
US

V. Phone/Fax

Practice location:
  • Phone: 480-272-5505
  • Fax: 480-987-6573
Mailing address:
  • Phone: 480-272-5505
  • Fax: 480-987-6573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-04760P
License Number StateAZ

VIII. Authorized Official

Name: MS. SALLY H DENNY
Title or Position: PRESIDENT
Credential: LMT
Phone: 480-272-5505