1427334028 NPI number — FOUNDATIONAL PHYSICAL THERAPY LLC

Table of content: (NPI 1427334028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427334028 NPI number — FOUNDATIONAL PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUNDATIONAL PHYSICAL THERAPY 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:
6
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:
1427334028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5590 W CHANDLER BLVD
Provider Second Line Business Mailing Address:
BLDG B STE 4
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85226-3697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-786-4969
Provider Business Mailing Address Fax Number:
480-786-5118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5590 W CHANDLER BLVD
Provider Second Line Business Practice Location Address:
BLDG B STE 4
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85226-3697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-786-4969
Provider Business Practice Location Address Fax Number:
480-786-5118
Provider Enumeration Date:
10/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTENSEN
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER DIRECTOR
Authorized Official Telephone Number:
480-786-4969

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XH1200X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

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




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