Healthcare Provider Details

I. General information

NPI: 1336149723
Provider Name (Legal Business Name): CACTUS PHYSICAL THERAPY LIMITED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34155 N SCOTTSDALE RD
SCOTTSDALE AZ
85262-1221
US

IV. Provider business mailing address

PO BOX 5914
CAREFREE AZ
85377-5914
US

V. Phone/Fax

Practice location:
  • Phone: 480-488-7018
  • Fax: 623-465-7653
Mailing address:
  • Phone: 623-465-7653
  • Fax: 623-465-7653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberAZ #617
License Number StateAZ

VIII. Authorized Official

Name: DR. RICHARD L. PAINCHAUD
Title or Position: V.P./SECRETARY & STATUTORY AGENT
Credential: PH.D.
Phone: 623-465-7653