Healthcare Provider Details

I. General information

NPI: 1407956352
Provider Name (Legal Business Name): DOUGLAS HOWARD P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 W DEER VALLEY RD SUITE 105
PEORIA AZ
85382-2101
US

IV. Provider business mailing address

1317 W VERMONT AVE
PHOENIX AZ
85013-1959
US

V. Phone/Fax

Practice location:
  • Phone: 623-376-9100
  • Fax: 623-376-9141
Mailing address:
  • Phone: 602-328-9327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5407
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: