Provider Demographics
NPI:1437471513
Name:LANDMARK PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:LANDMARK PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DISALVO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:623-229-4530
Mailing Address - Street 1:9364 E RAINTREE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2200
Mailing Address - Country:US
Mailing Address - Phone:480-661-1124
Mailing Address - Fax:480-661-1125
Practice Address - Street 1:9364 E RAINTREE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2200
Practice Address - Country:US
Practice Address - Phone:480-661-1124
Practice Address - Fax:480-661-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2014-08-20
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
AZ795294Medicaid