MEDICARE: CACTUS PHYSICAL THERAPY LIMITED, INC.

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	208100000X	Physical Medicine & Rehabilitation Physician	AZ #617	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0088730	OTHER	AZ	BCBS AZ
2	617	OTHER	AR	AZ PT
3	19070617	OTHER	AZ	I.C.A.

General Provider Information

NPI Number	:	1336149723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CACTUS PHYSICAL THERAPY LIMITED, INC.

Provider Business Mailing Address
First Line	:	PO BOX 5914
Second Line	:
City	:	CAREFREE
State	:	AZ
Zip	:	85377-5914
Country	:	US
Telephone Number	:	623-465-7653
Fax Number	:	623-465-7653

Provider Business Practice Location Address
First Line	:	34155 N SCOTTSDALE RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85262-1221
Country	:	US
Telephone Number	:	480-488-7018
Fax Number	:	623-465-7653

Authorized Official
Title or Position	:	V.P./SECRETARY & STATUTORY AGENT
Name	:	DR. RICHARD L. PAINCHAUD
Credential	:	PH.D.
Telephone Number	:	623-465-7653

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	08/22/2020

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