Provider Demographics
NPI:1245202456
Name:ALPHA AND OMEGA PHYSICAL THERAPY ACC
Entity Type:Organization
Organization Name:ALPHA AND OMEGA PHYSICAL THERAPY ACC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-278-5835
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:861 E COOLEY ST B
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-5121
Mailing Address - Country:US
Mailing Address - Phone:928-207-6873
Mailing Address - Fax:866-762-2534
Practice Address - Street 1:861 E COOLEY ST B
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5121
Practice Address - Country:US
Practice Address - Phone:928-537-2678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ78176OtherPTAN
AZZ78176OtherPTAN