Provider Demographics
NPI:1093789695
Name:PINNACLE PHYSICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:PINNACLE PHYSICAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-899-9829
Mailing Address - Street 1:3930 S. ALMA SCHOOL RD.,
Mailing Address - Street 2:#3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4510
Mailing Address - Country:US
Mailing Address - Phone:480-899-9829
Mailing Address - Fax:480-726-9829
Practice Address - Street 1:3930 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4497
Practice Address - Country:US
Practice Address - Phone:480-899-9829
Practice Address - Fax:480-726-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ69401Medicare ID - Type UnspecifiedMEDICARE GROUP ID#