Healthcare Provider Details

I. General information

NPI: 1447493226
Provider Name (Legal Business Name): BRIGHT HORIZON REHAB THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8718 W DEER VALLEY RD
PEORIA AZ
85382-2453
US

IV. Provider business mailing address

PO BOX 2477
GILBERT AZ
85299-2477
US

V. Phone/Fax

Practice location:
  • Phone: 623-334-5299
  • Fax: 480-635-0222
Mailing address:
  • Phone: 623-334-5299
  • Fax: 480-635-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROSARIO FASANO
Title or Position: OWNER/MEMBER
Credential:
Phone: 623-334-5299