Healthcare Provider Details

I. General information

NPI: 1942065966
Provider Name (Legal Business Name): FOUR PEAKS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7316 E SOUTHERN AVE UNIT 7323
MESA AZ
85216-5054
US

IV. Provider business mailing address

PO BOX 7323
MESA AZ
85216-7323
US

V. Phone/Fax

Practice location:
  • Phone: 480-818-5305
  • Fax:
Mailing address:
  • Phone: 480-818-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LISA CAMPAGNARI
Title or Position: OWNER
Credential: COTA/L
Phone: 480-818-5305