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General NPI Number Information
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NPI Number | 1740721406
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Entity Type | Organization
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Legal Business Name | TRAVELING PHYSICAL THERAPIST PLLC
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 520 W SHELDON ST STE 6
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City | PRESCOTT
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State | AZ
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Zip | 86301-2717
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Country | US
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Telephone | 928-515-1748
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Fax | 928-445-5054
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Provider Business Mailing Address
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Address Line | 353 CIMARRON CT
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City | PRESCOTT
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State | AZ
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Zip | 86301-1563
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Country | US
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Telephone | 928-515-4178
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Fax | 928-233-6932
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Authorized Official
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Title or Position | CEO
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Name | MS. BARBARA KAY BUTLER
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Credential | ORTHOTIST
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Telephone | 928-515-1748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | C51320
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License Number State | AZ
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