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General NPI Number Information
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NPI Number | 1124985411
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Entity Type | Organization
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Legal Business Name | GLORIOUS THERAPY SERVICES LLC
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 12164 E DOMNITCH DR
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City | VAIL
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State | AZ
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Zip | 85641-6873
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Country | US
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Telephone | 520-757-3035
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Fax |
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Provider Business Mailing Address
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Address Line | 12164 E DOMNITCH DR
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City | VAIL
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State | AZ
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Zip | 85641-6873
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Country | US
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Telephone | 520-757-3035
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER/AUTHORIZED OFFICIAL
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Name | OLUMAYOWA EGBERANMWEN ENOMA-YUSUF
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Credential | OTD, OTR/L
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Telephone | 520-757-3035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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