Healthcare Provider Details

I. General information

NPI: 1306525787
Provider Name (Legal Business Name): JDPHYSICALTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4114 N 28TH ST APT 2030
PHOENIX AZ
85016-5772
US

IV. Provider business mailing address

4114 N 28TH ST APT 2030
PHOENIX AZ
85016-5772
US

V. Phone/Fax

Practice location:
  • Phone: 310-896-1203
  • Fax:
Mailing address:
  • Phone: 310-896-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN DURNELL II
Title or Position: OWNER
Credential: PT, DPT
Phone: 310-896-1203