Provider Demographics
NPI:1225664576
Name:ENLIVEN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ENLIVEN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-206-6240
Mailing Address - Street 1:20914 W GRANADA RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-6582
Mailing Address - Country:US
Mailing Address - Phone:480-923-9554
Mailing Address - Fax:
Practice Address - Street 1:20914 W GRANADA RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-6582
Practice Address - Country:US
Practice Address - Phone:480-923-9554
Practice Address - Fax:480-573-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty