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General NPI Number Information
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NPI Number | 1518290030
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Entity Type | Organization
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Legal Business Name | ELDERCARE PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 02/14/2014
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Provider Practice Location Address
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Address Line | 2037 E PARK AVE
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City | GILBERT
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State | AZ
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Zip | 85234-6209
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Country | US
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Telephone | 480-201-0027
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Fax | 480-497-0416
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Provider Business Mailing Address
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Address Line | PO BOX 1971
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City | HIGLEY
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State | AZ
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Zip | 85236-1971
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Country | US
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Telephone | 480-201-0027
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Fax | 602-625-1194
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | DANIEL S FAIRBANK
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Credential |
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Telephone | 480-626-4766
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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 | 7240
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License Number State | AZ
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