MEDICARE: CLASSICAL 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	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760691448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLASSICAL PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	4045 N 7TH ST
Second Line	:	SUITE 220
City	:	PHOENIX
State	:	AZ
Zip	:	85014-4736
Country	:	US
Telephone Number	:	602-443-1030
Fax Number	:	602-443-1033

Provider Business Practice Location Address
First Line	:	4045 N 7TH ST
Second Line	:	SUITE 220
City	:	PHOENIX
State	:	AZ
Zip	:	85014-4736
Country	:	US
Telephone Number	:	602-443-1030
Fax Number	:	602-443-1033

Authorized Official
Title or Position	:	OWNER
Name	:	PETER J COLLA
Credential	:	PT
Telephone Number	:	602-443-1030

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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Directions to “CLASSICAL PHYSICAL THERAPY ” Practice Location

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