Healthcare Provider Details

I. General information

NPI: 1508753575
Provider Name (Legal Business Name): ELLSWORTH PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40975 N IRONWOOD DR STE C14
SAN TAN VALLEY AZ
85140-8906
US

IV. Provider business mailing address

40975 N ARBOR AVE
SAN TAN VALLEY AZ
85140-5416
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-3590
  • Fax: 480-359-2113
Mailing address:
  • Phone: 480-269-3590
  • Fax: 480-359-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PHILLIP ELLSWORTH
Title or Position: OWNER
Credential: PT
Phone: 480-269-3590