Healthcare Provider Details

I. General information

NPI: 1528209830
Provider Name (Legal Business Name): DESERT VALLEY PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 E RAY RD STE 101A
PHOENIX AZ
85044-4707
US

IV. Provider business mailing address

4350 E RAY RD STE 101A
PHOENIX AZ
85044-4707
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-5954
  • Fax: 480-704-5807
Mailing address:
  • Phone: 480-704-5954
  • Fax: 480-704-5807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JULIE A SORRICK
Title or Position: DIRECTOR
Credential: M.A. CCC-SLP
Phone: 480-704-5954