Healthcare Provider Details

I. General information

NPI: 1720296346
Provider Name (Legal Business Name): VINCENT PRAKASH PERIES JR. DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 E IRONWOOD SQUARE DR
SCOTTSDALE AZ
85258-4576
US

IV. Provider business mailing address

5039 E LUCIA DR
CAVE CREEK AZ
85331-2338
US

V. Phone/Fax

Practice location:
  • Phone: 480-778-1400
  • Fax: 480-778-0400
Mailing address:
  • Phone: 480-220-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6488
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number6488
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number6488
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: