Healthcare Provider Details

I. General information

NPI: 1124985411
Provider Name (Legal Business Name): GLORIOUS THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12164 E DOMNITCH DR
VAIL AZ
85641-6873
US

IV. Provider business mailing address

12164 E DOMNITCH DR
VAIL AZ
85641-6873
US

V. Phone/Fax

Practice location:
  • Phone: 520-757-3035
  • Fax:
Mailing address:
  • Phone: 520-757-3035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: OLUMAYOWA EGBERANMWEN ENOMA-YUSUF
Title or Position: OWNER/PROVIDER/AUTHORIZED OFFICIAL
Credential: OTD, OTR/L
Phone: 520-757-3035