Provider Demographics
NPI:1417596800
Name:DEDICATED THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:DEDICATED THERAPY SERVICES LLC
Other - Org Name:DEDICATED THERAPY SERVICE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAKKEDA
Authorized Official - Middle Name:N
Authorized Official - Last Name:RUBIN-DELONEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:623-688-0282
Mailing Address - Street 1:2320 E BASELINE RD STE 148-241
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6960
Mailing Address - Country:US
Mailing Address - Phone:623-688-0282
Mailing Address - Fax:602-347-0516
Practice Address - Street 1:2320 E BASELINE RD STE 148-241
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6960
Practice Address - Country:US
Practice Address - Phone:623-688-0282
Practice Address - Fax:602-347-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty