Healthcare Provider Details

I. General information

NPI: 1578592705
Provider Name (Legal Business Name): KC'S PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20612 N CAVE CREEK RD # F151
PHOENIX AZ
85024-4440
US

IV. Provider business mailing address

20612 N CAVE CREEK RD # F151
PHOENIX AZ
85024-4440
US

V. Phone/Fax

Practice location:
  • Phone: 602-237-5047
  • Fax: 602-237-5522
Mailing address:
  • Phone: 602-237-5047
  • Fax: 602-237-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberAZ3238
License Number StateAZ

VIII. Authorized Official

Name: MR. KERRY ALLEN HALCOMB
Title or Position: OWNER
Credential: PT
Phone: 602-237-5047