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General NPI Number Information
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NPI Number | 1225403371
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Entity Type | Organization
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Legal Business Name | EAST VALLEY PT, LLC.
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 235 E WARNER RD
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City | GILBERT
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State | AZ
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Zip | 85296-2972
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Country | US
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Telephone | 480-633-3151
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1697
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-1837
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY ROGERS
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Credential |
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Telephone | 480-633-3151
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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 | 6279
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License Number State | AZ
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