Healthcare Provider Details

I. General information

NPI: 1427989193
Provider Name (Legal Business Name): TODD HILDRETH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 E EMELITA AVE
MESA AZ
85206-2625
US

IV. Provider business mailing address

4218 E EMELITA AVE
MESA AZ
85206-2625
US

V. Phone/Fax

Practice location:
  • Phone: 480-818-2648
  • Fax:
Mailing address:
  • Phone: 480-818-2648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-013547
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: