Healthcare Provider Details

I. General information

NPI: 1659413904
Provider Name (Legal Business Name): CARLA MARGUERITE GAGLIOTTI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8505 E VALLEY VIEW RD SCOTTSDALE PUBLIC SCHOOLS MOHAVE DISTRICT ANNEX
SCOTTSDALE AZ
85250
US

IV. Provider business mailing address

9702 E FRIESS DR
SCOTTSDALE AZ
85260
US

V. Phone/Fax

Practice location:
  • Phone: 480-484-5085
  • Fax:
Mailing address:
  • Phone: 480-585-4326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2274
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: