Healthcare Provider Details

I. General information

NPI: 1528442472
Provider Name (Legal Business Name): LANDMARK PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 E SHEA BLVD STE 105
PHOENIX AZ
85028-6082
US

IV. Provider business mailing address

9364 E RAINTREE DR STE 103
SCOTTSDALE AZ
85260-2200
US

V. Phone/Fax

Practice location:
  • Phone: 480-661-1124
  • Fax: 480-661-1125
Mailing address:
  • Phone: 480-661-1124
  • Fax: 480-661-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER DISALVO
Title or Position: OWNER
Credential:
Phone: 480-661-1124