MEDICARE: PARADISE VALLEY PHYSICAL THERAPY, PLC

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	3297	AZ

General Provider Information

NPI Number	:	1811108541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADISE VALLEY PHYSICAL THERAPY, PLC

Provider Business Mailing Address
First Line	:	4550 E BELL RD
Second Line	:	BLDG 8 STE 270
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2158
Country	:	US
Telephone Number	:	602-424-0494
Fax Number	:	602-424-0493

Provider Business Practice Location Address
First Line	:	4550 E BELL RD
Second Line	:	BLDG 8 STE 270
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2159
Country	:	US
Telephone Number	:	602-424-0494
Fax Number	:	602-424-0493

Authorized Official
Title or Position	:	OWNER DIRECTOR
Name	:	MR. GREGG W POTTER
Credential	:	PT
Telephone Number	:	602-424-0494

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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