1245202456 NPI number — ALPHA AND OMEGA PHYSICAL THERAPY ACC

Table of content: (NPI 1245202456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245202456 NPI number — ALPHA AND OMEGA PHYSICAL THERAPY ACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA AND OMEGA PHYSICAL THERAPY ACC
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:
1245202456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 457
Provider Second Line Business Mailing Address:
861 E COOLEY ST B
Provider Business Mailing Address City Name:
SHOW LOW
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85901-5121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-207-6873
Provider Business Mailing Address Fax Number:
866-762-2534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
861 E COOLEY ST B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHOW LOW
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85901-5121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-537-2678
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COTTRELL
Authorized Official First Name:
SUZETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMIN
Authorized Official Telephone Number:
623-278-5835

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Z78176 . This is a "PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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