1255466231 NPI number — MS. KELLY ANNE VITZ P.T.

Table of content: MS. KELLY ANNE VITZ P.T. (NPI 1255466231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255466231 NPI number — MS. KELLY ANNE VITZ P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VITZ
Provider First Name:
KELLY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

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:
1255466231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4000
Provider Second Line Business Mailing Address:
PHYSICAL THERAPY DEPARTMENT
Provider Business Mailing Address City Name:
POLACCA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86042-4000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-737-6130
Provider Business Mailing Address Fax Number:
928-737-6153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HWY 264 MP 388
Provider Second Line Business Practice Location Address:
HHCC - PHYSICAL THERAPY DEPARTMENT
Provider Business Practice Location Address City Name:
POLACCA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86042-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-737-6130
Provider Business Practice Location Address Fax Number:
928-737-6153
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  7277 , 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)





Copyright © 2007-2025 www.npivalidator.com