Provider Demographics
NPI:1467830653
Name:PHYSIOTHERAPY ASSOCIATES
Entity Type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAVENDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:610-644-7824
Mailing Address - Street 1:2120 AIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3652
Mailing Address - Country:US
Mailing Address - Phone:928-757-1211
Mailing Address - Fax:928-757-8826
Practice Address - Street 1:2120 AIRWAY AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3652
Practice Address - Country:US
Practice Address - Phone:928-757-1211
Practice Address - Fax:928-757-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036550Medicare UPIN