Healthcare Provider Details

I. General information

NPI: 1629535356
Provider Name (Legal Business Name): GO BEYOND PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 E CAMELBACK RD STE 444
SCOTTSDALE AZ
85251-1257
US

IV. Provider business mailing address

7150 E CAMELBACK RD STE 444
SCOTTSDALE AZ
85251-1257
US

V. Phone/Fax

Practice location:
  • Phone: 617-803-7081
  • Fax: 800-852-1426
Mailing address:
  • Phone: 617-803-7081
  • Fax: 800-852-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROI DENNIS ADELA CAYETANO SMALLWOOD
Title or Position: CEO, CLINICIAN
Credential: PT, DPT
Phone: 617-803-7081