1811954803 NPI number — TIPTON PHYSICAL THERAPY, LLC

Table of content: (NPI 1811954803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811954803 NPI number — TIPTON PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIPTON 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:
TIPTON PHYSICAL THERAPY AND AQUATIC CENTER
Provider Other Organization Name Type Code:
3
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:
1811954803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2006
NPI Reactivation Date:
08/30/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8400 E FLORENTINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86314-8653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-775-9999
Provider Business Mailing Address Fax Number:
928-775-9998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8400 E FLORENTINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESCOTT VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86314-8653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-775-9999
Provider Business Practice Location Address Fax Number:
928-775-9998
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHELPS
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MEDICAL BILLING
Authorized Official Telephone Number:
928-775-9999

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5049 , 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)

  • Identifier: 115AZ60188 . This is a "TRIWEST DCN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 3Z2680 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 670847 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 707440 . This is a "WELLCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 191587 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106263700 . This is a "DEPT OF LABOR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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