MEDICARE: AGAPE THERAPY, LLC

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	224Z00000X	Occupational Therapy Assistant	3353	AZ
2	225100000X	Physical Therapist	6233	AZ
3	2251S0007X	Sports Physical Therapist	6233	AZ
4	225XH1200X	Hand Occupational Therapist
5	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1275856387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAPE THERAPY, LLC

Provider Business Mailing Address
First Line	:	6520 W HAPPY VALLEY RD
Second Line	:	B-109
City	:	GLENDALE
State	:	AZ
Zip	:	85310-2615
Country	:	US
Telephone Number	:	623-561-1300
Fax Number	:	623-561-0036

Provider Business Practice Location Address
First Line	:	6520 W HAPPY VALLEY RD
Second Line	:	B-109
City	:	GLENDALE
State	:	AZ
Zip	:	85310-2615
Country	:	US
Telephone Number	:	623-561-1300
Fax Number	:	623-561-0036

Authorized Official
Title or Position	:	MANAGER
Name	:	NANCY ALESKY
Credential	:
Telephone Number	:	623-561-1300

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	12/21/2011

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