Healthcare Provider Details

I. General information

NPI: 1912144072
Provider Name (Legal Business Name): PRITCHETTE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 E WARNER RD SUITE 10
PHOENIX AZ
85044-3320
US

IV. Provider business mailing address

4730 E WARNER RD SUITE 10
PHOENIX AZ
85044-3320
US

V. Phone/Fax

Practice location:
  • Phone: 480-785-5738
  • Fax:
Mailing address:
  • Phone: 480-785-5738
  • Fax: 480-785-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number6265
License Number StateAZ

VIII. Authorized Official

Name: DR. KEITH JAMES PRITCHETTE
Title or Position: PRESIDENT/DOCTOR OF PHYSICAL THERAP
Credential: DPT
Phone: 480-785-5738