Healthcare Provider Details

I. General information

NPI: 1942389564
Provider Name (Legal Business Name): PHYSIOTHERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N 7TH ST SUITE 100
PHOENIX AZ
85006-2754
US

IV. Provider business mailing address

707 LINCOLN CTR
STOCKTON CA
95207-2644
US

V. Phone/Fax

Practice location:
  • Phone: 602-271-4516
  • Fax: 602-271-9909
Mailing address:
  • Phone: 209-470-5101
  • Fax: 267-321-1287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CYNTHIA L GOLDBERG
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 610-644-7824