Healthcare Provider Details

I. General information

NPI: 1124057666
Provider Name (Legal Business Name): NORTHLAND THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1294 FAWNBROOK DRIVE
SHOWLOW AZ
85902
US

IV. Provider business mailing address

1294 FAWNBROOK DRIVE PO BOX 328
SHOWLOW AZ
85902
US

V. Phone/Fax

Practice location:
  • Phone: 928-532-1532
  • Fax: 928-532-1538
Mailing address:
  • Phone: 928-532-1532
  • Fax: 928-532-1538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JODY MARIE GASKILL
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 928-532-1532