Provider Demographics
NPI:1508021676
Name:INDEPENDENT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:INDEPENDENT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:TRESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-821-1997
Mailing Address - Street 1:13215 N VERDE RIVER DR
Mailing Address - Street 2:5
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-8308
Mailing Address - Country:US
Mailing Address - Phone:480-837-1530
Mailing Address - Fax:480-837-1545
Practice Address - Street 1:13215 N VERDE RIVER DR
Practice Address - Street 2:5
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-8308
Practice Address - Country:US
Practice Address - Phone:480-837-1530
Practice Address - Fax:480-837-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty