Provider Demographics
NPI:1508303462
Name:LANDMARK PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LANDMARK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DISALVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-229-4530
Mailing Address - Street 1:9364 E RAINTREE DR STE 103
Mailing Address - Street 2:
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 1:8220 N HAYDEN RD STE C108
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2574
Practice Address - Country:US
Practice Address - Phone:480-207-7197
Practice Address - Fax:480-661-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty