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General NPI Number Information
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NPI Number | 1629935481
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Entity Type | Organization
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Legal Business Name | EVEREST PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 4864 E BASELINE RD STE 105
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City | MESA
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State | AZ
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Zip | 85206-4629
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Country | US
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Telephone | 480-734-5595
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Fax | 480-633-6086
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Provider Business Mailing Address
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Address Line | 4864 E BASELINE RD STE 105
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City | MESA
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State | AZ
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Zip | 85206-4629
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Country | US
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Telephone | 480-734-5595
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Fax | 480-633-6086
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Authorized Official
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Title or Position | CEO
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Name | CYNTHIA RUDDELL
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Credential | CCC-SLP
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Telephone | 480-734-5595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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