Healthcare Provider Details

I. General information

NPI: 1740196625
Provider Name (Legal Business Name): IMPACT PHYSICAL THERAPY #4, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 E CAMELBACK RD # PD01
PHOENIX AZ
85016-4158
US

IV. Provider business mailing address

7228 W EMILE ZOLA AVE
PEORIA AZ
85381-5507
US

V. Phone/Fax

Practice location:
  • Phone: 623-208-7575
  • Fax:
Mailing address:
  • Phone: 623-208-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERIC HEFFERON
Title or Position: OWNER/CEO
Credential: PT, DPT
Phone: 602-639-1066