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General NPI Number Information
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NPI Number | 1992825830
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Entity Type | Organization
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Legal Business Name | ARIZONA SERVICES FOR DEVELOPMENTAL THERAPY INC
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Dates
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Enumeration Date | 03/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2101 E PAGE AVE
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City | GILBERT
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State | AZ
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Zip | 85234-6212
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Country | US
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Telephone | 480-926-1399
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 E PAGE AVE
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City | GILBERT
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State | AZ
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Zip | 85234-6212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER PHYSICAL THERAPIST
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Name | ROXANNE SMALL
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Credential | PT
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Telephone | 480-926-1399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 0503
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License Number State | AZ
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