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General NPI Number Information
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NPI Number | 1932439031
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY OF TEMPE
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 1030 E BASELINE RD STE 178
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City | TEMPE
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State | AZ
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Zip | 85283-1371
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Country | US
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Telephone | 480-755-7868
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Fax | 480-755-7871
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Provider Business Mailing Address
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Address Line | 1030 E BASELINE RD STE 178
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City | TEMPE
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State | AZ
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Zip | 85283-1371
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Country | US
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Telephone | 480-755-7868
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Fax | 480-755-7871
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | ERIC MOODY
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Credential |
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Telephone | 480-755-7868
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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 | 6614
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License Number State | AZ
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