MEDICARE: IDEAL PHYSICAL THERAPY

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	7992	AZ

General Provider Information

NPI Number	:	1295139202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	2005 W HAPPY VALLEY RD STE 170
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-2898
Country	:	US
Telephone Number	:	623-780-3555
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 W HAPPY VALLEY RD
Second Line	:	170
City	:	PHOENIX
State	:	AZ
Zip	:	85085-2893
Country	:	US
Telephone Number	:	623-780-3555
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	BARB DAVIS
Credential	:
Telephone Number	:	602-697-3488

Provider Enumeration Date	:	10/20/2014
Last Update Date	:	10/20/2014

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Directions to “IDEAL PHYSICAL THERAPY ” Practice Location

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