Provider Demographics
NPI:1154628584
Name:SOUTHWOOD PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:SOUTHWOOD PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:AMA
Authorized Official - Last Name:SOUTHWOOD-EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-431-7918
Mailing Address - Street 1:42829 W WILD HORSE TRL
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-8271
Mailing Address - Country:US
Mailing Address - Phone:520-431-7918
Mailing Address - Fax:
Practice Address - Street 1:44480 W HONEYCUTT AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2903
Practice Address - Country:US
Practice Address - Phone:520-582-0142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ171R00000X171R00000X
NE225X00000X225X00000X
AZ235Z00000X235Z00000X
NE261QP2000X261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No171R00000XOther Service ProvidersInterpreterGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty