Healthcare Provider Details

I. General information

NPI: 1366166134
Provider Name (Legal Business Name): KATHERINE ELIZABETH DELOACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 E WILLETTA ST
PHOENIX AZ
85006-2723
US

IV. Provider business mailing address

2595 S COMANCHE DR
CHANDLER AZ
85286-4351
US

V. Phone/Fax

Practice location:
  • Phone: 480-581-3900
  • Fax:
Mailing address:
  • Phone: 678-457-1418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License NumberOT-008763
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: