Healthcare Provider Details

I. General information

NPI: 1124738109
Provider Name (Legal Business Name): ALLEGIANT THERAPY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 W MALDONADO RD
PHOENIX AZ
85041-6318
US

IV. Provider business mailing address

3406 W MALDONADO RD
PHOENIX AZ
85041-6318
US

V. Phone/Fax

Practice location:
  • Phone: 480-913-0053
  • Fax:
Mailing address:
  • Phone: 480-913-0053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224ZR0403X
TaxonomyDriving and Community Mobility Occupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN SEGURA
Title or Position: OWNER
Credential:
Phone: 480-913-0053