1750370169 NPI number — INSTITUTE FOR PHYSICAL THERAPY

Table of content: JESSICA JULIA ENNY M.A. (NPI 1760854616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750370169 NPI number — INSTITUTE FOR PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE FOR PHYSICAL THERAPY
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:
1750370169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8070 E MORGAN TRL
Provider Second Line Business Mailing Address:
#202
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85258-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-922-1376
Provider Business Mailing Address Fax Number:
480-922-8783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8070 E MORGAN TRL
Provider Second Line Business Practice Location Address:
#202
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85258-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-922-1376
Provider Business Practice Location Address Fax Number:
480-922-8783
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLACK
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-922-1376

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5877 , 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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