Healthcare Provider Details

I. General information

NPI: 1467476705
Provider Name (Legal Business Name): DANA S DOUGLASS PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 N HAYDEN RD STE B2
SCOTTSDALE AZ
85260-2931
US

IV. Provider business mailing address

14201 N HAYDEN RD STE B2
SCOTTSDALE AZ
85260-2931
US

V. Phone/Fax

Practice location:
  • Phone: 480-268-9078
  • Fax: 480-275-7134
Mailing address:
  • Phone: 480-268-9078
  • Fax: 480-275-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2997
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: