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General NPI Number Information
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NPI Number | 1891212460
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Entity Type | Organization
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Legal Business Name | CANYON PHYSICAL THERAPY SURPRISE LLC
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 16968 W BELL RD STE 401
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City | SURPRISE
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State | AZ
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Zip | 85374-8943
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Country | US
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Telephone | 623-374-2910
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Fax |
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Provider Business Mailing Address
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Address Line | 16968 W BELL RD BLD D SUITE 401
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City | SURPRISE
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State | AZ
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Zip | 85374
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Country | US
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Telephone | 623-374-2910
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Fax |
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Authorized Official
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Title or Position | OWNER / CEO
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Name | SCOTT GILBERT
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Credential | PT, DPT
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Telephone | 623-374-2910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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