Provider Demographics
NPI:1508931569
Name:FIESTA PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:FIESTA PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-265-4124
Mailing Address - Street 1:1641 E OSBORN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7146
Mailing Address - Country:US
Mailing Address - Phone:602-265-4124
Mailing Address - Fax:602-248-8843
Practice Address - Street 1:930 W SOUTHERN AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4938
Practice Address - Country:US
Practice Address - Phone:480-835-0857
Practice Address - Fax:480-898-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty