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General NPI Number Information
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NPI Number | 1225033483
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Entity Type | Organization
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Legal Business Name | PALO VERDE PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 3003 HIWAY 95 STE 61
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-7896
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Country | US
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Telephone | 928-758-0029
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Fax | 928-758-0055
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Provider Business Mailing Address
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Address Line | 3003 HIGHWAY 95 STE 61
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-7896
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Country | US
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Telephone | 928-758-0029
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Fax | 928-758-0055
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Authorized Official
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Title or Position | OWNER
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Name | CAROL DIEHL
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Credential |
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Telephone | 928-758-0029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 4214
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1526
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License Number State | AZ
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