Provider Demographics
NPI:1528011178
Name:ON THE MEND ON THE MOVE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:ON THE MEND ON THE MOVE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-354-2911
Mailing Address - Street 1:11421 E DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-2343
Mailing Address - Country:US
Mailing Address - Phone:480-354-2911
Mailing Address - Fax:480-984-3169
Practice Address - Street 1:11421 E DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-2343
Practice Address - Country:US
Practice Address - Phone:480-354-2911
Practice Address - Fax:480-984-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ108120Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION