Healthcare Provider Details

I. General information

NPI: 1609105931
Provider Name (Legal Business Name): PHYSICAL THERAPY OF SONOITA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SHERWOOD FOREST LANE
SONOITA AZ
85637
US

IV. Provider business mailing address

PO BOX 776
SONOITA AZ
85637-0776
US

V. Phone/Fax

Practice location:
  • Phone: 520-455-5439
  • Fax: 520-455-5439
Mailing address:
  • Phone: 520-455-5439
  • Fax: 520-455-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2699
License Number StateAZ

VIII. Authorized Official

Name: MS. BRIDGET A MEYERS GAINES
Title or Position: OWNER
Credential: M.P.T.
Phone: 520-455-5439