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General NPI Number Information
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NPI Number | 1114032000
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Entity Type | Organization
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Legal Business Name | VIKING THERAPY, LTD.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2093 E WILLOW WICK RD
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City | GILBERT
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State | AZ
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Zip | 85296-2747
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Country | US
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Telephone | 480-205-6917
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Fax |
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Provider Business Mailing Address
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Address Line | 2093 E WILLOW WICK RD
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City | GILBERT
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State | AZ
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Zip | 85296-2747
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Country | US
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Telephone | 480-205-6917
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Fax | 480-361-4420
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. MARK CHARLES KAHLBAUGH
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Credential | OT
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Telephone | 480-205-6917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 2559
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License Number State | AZ
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