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General NPI Number Information
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NPI Number | 1902461312
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Entity Type | Organization
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Legal Business Name | MIGHTY OAKS THERAPY PLLC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 20329 N 59TH AVE STE A5
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City | GLENDALE
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State | AZ
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Zip | 85308-6854
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Country | US
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Telephone | 630-956-1080
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Fax |
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Provider Business Mailing Address
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Address Line | 26907 N 51ST DR
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City | PHOENIX
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State | AZ
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Zip | 85083-1279
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Country | US
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Telephone | 630-956-1080
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MRS. ELIZABETH ANNE RAKOZY
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Credential | SLP
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Telephone | 630-956-1080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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