Provider Demographics
NPI:1437637220
Name:CENTRAL ARIZONA SPORTS AND PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:CENTRAL ARIZONA SPORTS AND PHYSICAL THERAPY, LLC
Other - Org Name:CENTRAL ARIZONA SPORTS AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT, AT/L
Authorized Official - Phone:928-300-1936
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-0518
Mailing Address - Country:US
Mailing Address - Phone:928-300-1936
Mailing Address - Fax:928-567-8826
Practice Address - Street 1:155 S MONTEZUMA CASTLE HWY STE 2
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7393
Practice Address - Country:US
Practice Address - Phone:928-300-1936
Practice Address - Fax:928-567-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7402261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy