Healthcare Provider Details

I. General information

NPI: 1467830653
Provider Name (Legal Business Name): PHYSIOTHERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 AIRWAY AVE
KINGMAN AZ
86409-3652
US

IV. Provider business mailing address

2120 AIRWAY AVE
KINGMAN AZ
86409-3652
US

V. Phone/Fax

Practice location:
  • Phone: 928-757-1211
  • Fax: 928-757-8826
Mailing address:
  • Phone: 928-757-1211
  • Fax: 928-757-8826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HANK BALAVENDER
Title or Position: CEO
Credential: PT
Phone: 610-644-7824