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General NPI Number Information
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NPI Number | 1932569746
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Entity Type | Organization
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Legal Business Name | PERMAR PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 143 N MCCORMICK ST STE 102
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City | PRESCOTT
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State | AZ
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Zip | 86301-2725
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Country | US
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Telephone | 928-589-1172
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Fax | 928-441-2622
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Provider Business Mailing Address
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Address Line | 19 EASTFIELD LN
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City | PRESCOTT
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State | AZ
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Zip | 86305-5272
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Country | US
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Telephone | 928-589-1172
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Fax | 928-441-2622
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | GAGE PERMAR
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Credential |
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Telephone | 928-589-1172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8201
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License Number State | AZ
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