Healthcare Provider Details

I. General information

NPI: 1144593609
Provider Name (Legal Business Name): DENNIS R. ST JAMES PHYSICAL THERAPY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 EAST MARYLAND AVE SUITE C
PHOENIX AZ
85012
US

IV. Provider business mailing address

532 E MARYLAND AVENUE STE C
PHOENIX AZ
85018
US

V. Phone/Fax

Practice location:
  • Phone: 602-266-9922
  • Fax:
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 Number188649400
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number188649400
License Number StateAZ

VIII. Authorized Official

Name: MR. DENNIS R ST JAMES
Title or Position: OWNER AND PHYSICAL THERAPIST
Credential: PT
Phone: 602-266-9922