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General NPI Number Information
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NPI Number | 1558951228
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Entity Type | Organization
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Legal Business Name | VITALITY PERFORMANCE AND PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 19888 N 73RD AVE
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City | GLENDALE
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State | AZ
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Zip | 85308-8904
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Country | US
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Telephone | 888-620-6202
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 W ROSE GARDEN LN
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City | PHOENIX
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State | AZ
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Zip | 85027-2615
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Country | US
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Telephone | 888-620-6202
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAN DE LA CRUZ
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Credential |
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Telephone | 623-498-7881
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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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