Provider Demographics
NPI:1245749399
Name:PALADINO PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:PALADINO PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:B
Authorized Official - Last Name:PALADINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:623-824-2785
Mailing Address - Street 1:12861 W PALO BREA LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4419
Mailing Address - Country:US
Mailing Address - Phone:623-824-2785
Mailing Address - Fax:623-518-2997
Practice Address - Street 1:9049 W LAKE PLEASANT PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8361
Practice Address - Country:US
Practice Address - Phone:623-824-2785
Practice Address - Fax:623-518-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ68122251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1003848680OtherAZ