Healthcare Provider Details

I. General information

NPI: 1386721512
Provider Name (Legal Business Name): NEUROLOGIC THERAPY SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5017 E WASHINGTON ST # 107A
PHOENIX AZ
85034-2033
US

IV. Provider business mailing address

5017 E WASHINGTON ST # 107A
PHOENIX AZ
85034-2033
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-1073
  • Fax: 602-277-1016
Mailing address:
  • Phone: 602-277-1073
  • Fax: 602-277-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number6092
License Number StateAZ

VIII. Authorized Official

Name: DANIEL BONAROTI
Title or Position: OWNER
Credential:
Phone: 602-277-1073