=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831914837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAR PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2024
-----------------------------------------------------
Last Update Date | 11/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3830 E RAY RD
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85044-7158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-770-0752
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18429 W WHISPERING WIND DR
-----------------------------------------------------
City | WITTMANN
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85361-5445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | WESLEY DESROSIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 623-252-8433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------