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General NPI Number Information
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NPI Number | 1053122689
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Entity Type | Organization
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Legal Business Name | PHOENIX MOUNTAIN THERAPY LLC
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 7370 E GOLD DUST AVE RM 212
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-1025
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Country | US
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Telephone | 602-816-3924
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Fax | 480-701-9773
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Provider Business Mailing Address
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Address Line | 7370 E GOLD DUST AVE RM 212
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-1025
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Country | US
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Telephone | 602-816-3924
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Fax | 480-701-9773
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Authorized Official
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Title or Position | SECRETARY
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Name | SOON BURNAM
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Credential |
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Telephone | 949-540-1249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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