Provider Demographics
NPI:1124011812
Name:ABOVE & BEYOND THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ABOVE & BEYOND THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-866-2231
Mailing Address - Street 1:3233 W PEORIA AVE
Mailing Address - Street 2:SUITE 224
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4614
Mailing Address - Country:US
Mailing Address - Phone:602-866-2231
Mailing Address - Fax:602-866-2261
Practice Address - Street 1:3233 W PEORIA AVE
Practice Address - Street 2:SUITE 224
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4614
Practice Address - Country:US
Practice Address - Phone:602-866-2231
Practice Address - Fax:602-866-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225100000X, 261QP2000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ637689Medicaid
AZZ104361Medicare PIN