Healthcare Provider Details

I. General information

NPI: 1720452543
Provider Name (Legal Business Name): BASHA PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8058 E. VIA BONITA
SCOTTSDALE AZ
85258
US

IV. Provider business mailing address

P.O.BOX 267
QUEEN CREEK AZ
85142
US

V. Phone/Fax

Practice location:
  • Phone: 480-848-4281
  • Fax: 480-393-7040
Mailing address:
  • Phone: 480-848-4281
  • Fax: 480-393-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number6944
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number6944
License Number StateAZ

VIII. Authorized Official

Name: ROBERT BASHA
Title or Position: MANAGER
Credential:
Phone: 480-848-4281