Provider Demographics
NPI:1407031826
Name:ABOVE & BEYOND PHYSICAL THERAPY OF SEDONA
Entity Type:Organization
Organization Name:ABOVE & BEYOND PHYSICAL THERAPY OF SEDONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-203-0087
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-0776
Mailing Address - Country:US
Mailing Address - Phone:928-639-0166
Mailing Address - Fax:928-639-0167
Practice Address - Street 1:1835 W HIGHWAY 89A
Practice Address - Street 2:SUITE 6
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5570
Practice Address - Country:US
Practice Address - Phone:928-282-2411
Practice Address - Fax:928-282-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2011-02-18
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
AZ294682Medicaid
AZZ120023Medicare PIN