MEDICARE: ITHERAPY, 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	251E00000X	Home Health Agency	5235	AZ

General Provider Information

NPI Number	:	1306189436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITHERAPY, LLC

Provider Business Mailing Address
First Line	:	3442 W LOS GATOS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-1652
Country	:	US
Telephone Number	:	309-536-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3442 W LOS GATOS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-1652
Country	:	US
Telephone Number	:	309-536-2100
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	RYAN SHERMAN
Credential	:	MOTR/L
Telephone Number	:	309-536-2100

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	03/27/2013

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