Provider Demographics
NPI:1386012870
Name:PROTHERAPY STAFFING
Entity Type:Organization
Organization Name:PROTHERAPY STAFFING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHUDA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:260-241-7887
Mailing Address - Street 1:219 MILK RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT PECK
Mailing Address - State:MT
Mailing Address - Zip Code:59223
Mailing Address - Country:US
Mailing Address - Phone:605-593-6700
Mailing Address - Fax:
Practice Address - Street 1:402 E GREENWAY PKWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2350
Practice Address - Country:US
Practice Address - Phone:602-789-6878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11779261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy