Provider Demographics
NPI:1093180127
Name:NORTHERN ARIZONA PHYSICAL THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:NORTHERN ARIZONA PHYSICAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:III
Authorized Official - Credentials:PTA
Authorized Official - Phone:928-715-7777
Mailing Address - Street 1:2404 N STOCKTON HILL RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4184
Mailing Address - Country:US
Mailing Address - Phone:928-715-7777
Mailing Address - Fax:928-718-6366
Practice Address - Street 1:2404 N STOCKTON HILL RD
Practice Address - Street 2:SUITE K
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4184
Practice Address - Country:US
Practice Address - Phone:928-715-7777
Practice Address - Fax:928-718-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10984261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy