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General NPI Number Information
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NPI Number | 1710487707
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Entity Type | Organization
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Legal Business Name | DESERT EDGE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 02/15/2018
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 10100 W. LAKE PLEASANT PARKWAY SUITE 1300
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City | PEORIA
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State | AZ
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Zip | 85382
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Country | US
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Telephone | 623-334-8767
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Fax | 623-566-5993
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Provider Business Mailing Address
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Address Line | 10100 W. LAKE PLEASANT PARKWAY SUITE 1300
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City | PEORIA
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State | AZ
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Zip | 85382
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Country | US
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Telephone | 623-334-8767
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Fax | 623-566-5993
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MICHAEL KING
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Credential | P.T.
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Telephone | 623-235-5772
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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 | 11446
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License Number State | AZ
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