Healthcare Provider Details

I. General information

NPI: 1154847820
Provider Name (Legal Business Name): AMISHA VARGAS COVARRUBIAS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10861 E BASELINE RD STE 105A
MESA AZ
85209-7922
US

IV. Provider business mailing address

1059 W CORNELL DR
TEMPE AZ
85283-1652
US

V. Phone/Fax

Practice location:
  • Phone: 520-231-1360
  • Fax: 480-284-5952
Mailing address:
  • Phone: 520-231-1360
  • Fax: 480-284-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-31570
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: