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General NPI Number Information
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NPI Number | 1811226103
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Entity Type | Organization
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Legal Business Name | ACHIEVE PHYSICAL THERAPY OF ARIZONA, PLLC
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 17235 N 75TH AVE SUITE 135
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 602-314-2747
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Fax | 602-314-2748
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Provider Business Mailing Address
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Address Line | 17235 N 75TH AVE STE E145
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City | GLENDALE
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State | AZ
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Zip | 85308-0867
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Country | US
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Telephone | 623-201-7210
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Fax | 623-201-7214
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Authorized Official
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Title or Position | OWNER
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Name | DAVID ELI HAWKINS
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Credential | PT
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Telephone | 623-201-7210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8768
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License Number State | AZ
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