Healthcare Provider Details

I. General information

NPI: 1003933458
Provider Name (Legal Business Name): DENNIS R. ST JAMES PHYSICAL THERAPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 E MARYLAND AVE SUITE C
PHOENIX AZ
85012-1143
US

IV. Provider business mailing address

532 E MARYLAND AVE SUITE C
PHOENIX AZ
85012-1143
US

V. Phone/Fax

Practice location:
  • Phone: 602-266-9922
  • Fax: 602-266-6533
Mailing address:
  • Phone: 602-266-9922
  • Fax: 602-266-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number785
License Number StateAZ

VIII. Authorized Official

Name: DENNIS R ST JAMES
Title or Position: OWNER
Credential: PT
Phone: 602-266-9922