Provider Demographics
NPI:1053847582
Name:CROSSROADS ORTHOPEDIC PT
Entity Type:Organization
Organization Name:CROSSROADS ORTHOPEDIC PT
Other - Org Name:CROSSROADS ORTHOPEDIC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:480-772-7532
Mailing Address - Street 1:2280 S ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7763
Mailing Address - Country:US
Mailing Address - Phone:480-772-7532
Mailing Address - Fax:
Practice Address - Street 1:610 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE 52
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3600
Practice Address - Country:US
Practice Address - Phone:480-772-7532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6170261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy