Healthcare Provider Details

I. General information

NPI: 1649504572
Provider Name (Legal Business Name): AMPLITUDE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7539 E DE LA O RD
SCOTTSDALE AZ
85255-2747
US

IV. Provider business mailing address

7539 E DE LA O RD
SCOTTSDALE AZ
85255-2747
US

V. Phone/Fax

Practice location:
  • Phone: 480-563-9670
  • Fax:
Mailing address:
  • Phone: 480-563-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2132
License Number StateAZ

VIII. Authorized Official

Name: MR. EVERETT S. SMITH
Title or Position: MEMBER
Credential:
Phone: 480-563-9670