=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841682671
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEY PHYSICAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2015
-----------------------------------------------------
Last Update Date | 06/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34597 N 60TH ST SUITE 100
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85266-5240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-588-7979
-----------------------------------------------------
Fax | 480-588-5448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34597 N 60TH ST SUITE 100
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85266-5240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-588-7979
-----------------------------------------------------
Fax | 480-588-5448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PT/OWNER
-----------------------------------------------------
Name | MR. MICHAEL RYAN KALER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 602-320-5060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2251S0007X
-----------------------------------------------------
Taxonomy Name | Sports Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------