Provider Demographics
NPI:1225087158
Name:CANYON STATE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CANYON STATE PHYSICAL THERAPY
Other - Org Name:PHYSICIANS PHYSICAL THERAPY SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PERCY-FINE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:623-915-2726
Mailing Address - Street 1:8811 N 51ST AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-4949
Mailing Address - Country:US
Mailing Address - Phone:623-915-2726
Mailing Address - Fax:623-915-2728
Practice Address - Street 1:8811 N 51ST AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4949
Practice Address - Country:US
Practice Address - Phone:623-915-2726
Practice Address - Fax:623-915-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty