Healthcare Provider Details

I. General information

NPI: 1871769976
Provider Name (Legal Business Name): SONORAN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W RIO SALADO PKWY STE 107
TEMPE AZ
85281-2892
US

IV. Provider business mailing address

1432 S DOBSON RD SUITE 201
MESA AZ
85202-4768
US

V. Phone/Fax

Practice location:
  • Phone: 480-962-0071
  • Fax: 480-962-0590
Mailing address:
  • Phone: 480-962-0071
  • Fax: 480-962-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY GARCIA
Title or Position: BILLING MANAGER
Credential: MANAGER
Phone: 602-443-4196