MEDICARE: FOUR PEAKS PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	1208	AZ

General Provider Information

NPI Number	:	1235231101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR PEAKS PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	3200 N DOBSON RD
Second Line	:	SUITE D-1
City	:	CHANDLER
State	:	AZ
Zip	:	85224-9601
Country	:	US
Telephone Number	:	480-820-3101
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 N DOBSON RD
Second Line	:	SUITE D-1
City	:	CHANDLER
State	:	AZ
Zip	:	85224-9601
Country	:	US
Telephone Number	:	480-820-3101
Fax Number	:	480-820-8423

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUSAN ANNETTE DAHLSTEDT
Credential	:	PT, DPT
Telephone Number	:	480-820-3101

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	08/22/2020

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