1871751347 NPI number — SOUTHWEST PHYSICAL THERAPY AND REHAB LLC

Table of content: (NPI 1871751347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871751347 NPI number — SOUTHWEST PHYSICAL THERAPY AND REHAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST PHYSICAL THERAPY AND REHAB 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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1871751347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1760 E FLORENCE BLVD
Provider Second Line Business Mailing Address:
SUITE #150
Provider Business Mailing Address City Name:
CASA GRANDE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85222-4764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-876-9064
Provider Business Mailing Address Fax Number:
520-876-9145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1760 E FLORENCE BLVD
Provider Second Line Business Practice Location Address:
SUITE #150
Provider Business Practice Location Address City Name:
CASA GRANDE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85222-4764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-876-9064
Provider Business Practice Location Address Fax Number:
520-876-9145
Provider Enumeration Date:
05/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
KIRTI
Authorized Official Middle Name:
MINESH
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
520-876-9064

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  6067 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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