Provider Demographics
NPI:1235231101
Name:FOUR PEAKS PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:FOUR PEAKS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:DAHLSTEDT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:480-820-3101
Mailing Address - Street 1:3200 N DOBSON RD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-9601
Mailing Address - Country:US
Mailing Address - Phone:480-820-3101
Mailing Address - Fax:
Practice Address - Street 1:3200 N DOBSON RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-9601
Practice Address - Country:US
Practice Address - Phone:480-820-3101
Practice Address - Fax:480-820-8423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1208261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ78402Medicare ID - Type Unspecified