1023358512 NPI number — THERAPY ACCOMPLISHED LLC

Table of content: (NPI 1023358512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023358512 NPI number — THERAPY ACCOMPLISHED LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY ACCOMPLISHED LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023358512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 155
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUCCA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86438-0155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-279-3652
Provider Business Mailing Address Fax Number:
888-446-5008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11071 S CAMELBACK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCCA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86438-0155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-279-3652
Provider Business Practice Location Address Fax Number:
888-446-5008
Provider Enumeration Date:
02/21/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCNEIL
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/ PHYSICAL THERAPIST
Authorized Official Telephone Number:
928-279-3652

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 803334 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".