Healthcare Provider Details

I. General information

NPI: 1376536250
Provider Name (Legal Business Name): ANNA CARDOSA GRAY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA L CARDOSA M.P.T.

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 N 15TH AVE
PHOENIX AZ
85007-1201
US

IV. Provider business mailing address

4948 W PURDUE AVE
GLENDALE AZ
85302-3530
US

V. Phone/Fax

Practice location:
  • Phone: 623-242-6908
  • Fax: 623-242-6909
Mailing address:
  • Phone: 623-512-6156
  • Fax: 800-915-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT6191
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberLPT6191
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: