Provider Demographics
NPI:1336699115
Name:THEREX UNLIMITED PHYSICAL REHAB LLC
Entity Type:Organization
Organization Name:THEREX UNLIMITED PHYSICAL REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DEMARKIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:810-577-5066
Mailing Address - Street 1:44042 W PALO TECA RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-3600
Mailing Address - Country:US
Mailing Address - Phone:810-577-5066
Mailing Address - Fax:480-485-8535
Practice Address - Street 1:44042 W PALO TECA RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-3600
Practice Address - Country:US
Practice Address - Phone:810-577-5066
Practice Address - Fax:480-485-8535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11818PT251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health