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General NPI Number Information
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NPI Number | 1609237635
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Entity Type | Organization
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Legal Business Name | DESERT DOLPHIN AQUATIC THERAPY & REHAB
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 1903 S COLE DR
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City | GILBERT
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State | AZ
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Zip | 85295
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Country | US
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Telephone | 480-760-3458
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Fax |
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Provider Business Mailing Address
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Address Line | 1903 S COLE DR
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City | GILBERT
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State | AZ
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Zip | 85295
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Country | US
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Telephone | 480-760-3458
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | BONNIE SANTOS
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Credential | PHYSICAL THERAPIST
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Telephone | 480-760-3458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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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