Provider Demographics
NPI:1235200569
Name:PRO MOTION PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PRO MOTION PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:623-873-4000
Mailing Address - Street 1:6535 W CAMELBACK RD STE 6
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-1608
Mailing Address - Country:US
Mailing Address - Phone:623-873-4000
Mailing Address - Fax:623-873-9000
Practice Address - Street 1:6535 W CAMELBACK RD STE 6
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-1608
Practice Address - Country:US
Practice Address - Phone:623-873-4000
Practice Address - Fax:623-873-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ101748Medicare PIN