Healthcare Provider Details

I. General information

NPI: 1275692089
Provider Name (Legal Business Name): SAGUARO THERAPY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 W 24TH ST
YUMA AZ
85364-6205
US

IV. Provider business mailing address

1224 S 41ST DR
YUMA AZ
85364-4075
US

V. Phone/Fax

Practice location:
  • Phone: 928-210-2339
  • Fax: 928-819-7019
Mailing address:
  • Phone: 928-210-2413
  • Fax: 928-819-7019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5016
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP0892
License Number StateAZ

VIII. Authorized Official

Name: MS. MEG WAGNER RODNEY
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 928-210-2413