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General NPI Number Information
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NPI Number | 1639472244
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Entity Type | Organization
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Legal Business Name | GILBERT PT, LLC
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Dates
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Enumeration Date | 12/21/2010
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 610 N GILBERT RD SUITE 309
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City | GILBERT
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State | AZ
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Zip | 85234-4502
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Country | US
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Telephone | 480-926-1111
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Fax | 480-926-2958
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Provider Business Mailing Address
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Address Line | 3004 N CIVIC CENTER PLZ
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-6904
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Country | US
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Telephone | 480-990-7676
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Fax | 480-990-8222
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN M EBY
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Credential |
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Telephone | 602-679-7676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7280
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 27848
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP3957
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License Number State | AZ
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