Provider Demographics
NPI:1114032000
Name:VIKING THERAPY, LTD.
Entity Type:Organization
Organization Name:VIKING THERAPY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KAHLBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:480-205-6917
Mailing Address - Street 1:2093 E WILLOW WICK RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2747
Mailing Address - Country:US
Mailing Address - Phone:480-205-6917
Mailing Address - Fax:480-361-4420
Practice Address - Street 1:2093 E WILLOW WICK RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2747
Practice Address - Country:US
Practice Address - Phone:480-205-6917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2559251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health