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General NPI Number Information
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NPI Number | 1174661185
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Entity Type | Organization
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Legal Business Name | RESOURCE PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 825 W MINGUS AVE
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4088
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Country | US
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Telephone | 928-639-3068
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Fax | 928-639-3346
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Provider Business Mailing Address
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Address Line | PO BOX 2024
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City | COTTONWOOD
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State | AZ
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Zip | 86326-2024
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Country | US
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Telephone | 928-639-3068
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Fax | 928-639-3346
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SANDRA MARIE HETRICK
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Credential |
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Telephone | 928-639-3068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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