Healthcare Provider Details

I. General information

NPI: 1124011812
Provider Name (Legal Business Name): ABOVE & BEYOND THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 W PEORIA AVE SUITE 224
PHOENIX AZ
85029-4614
US

IV. Provider business mailing address

3233 W PEORIA AVE SUITE 224
PHOENIX AZ
85029-4614
US

V. Phone/Fax

Practice location:
  • Phone: 602-866-2231
  • Fax: 602-866-2261
Mailing address:
  • Phone: 602-866-2231
  • Fax: 602-866-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. THOMAS J LONG
Title or Position: OWNER/PT
Credential: PT
Phone: 602-866-2231