Provider Demographics
NPI:1528381316
Name:DESERT VALLEY PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:DESERT VALLEY PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-990-5766
Mailing Address - Street 1:12501 E CAPE HORN DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9104
Mailing Address - Country:US
Mailing Address - Phone:520-990-5766
Mailing Address - Fax:520-325-4012
Practice Address - Street 1:3002 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1603
Practice Address - Country:US
Practice Address - Phone:520-990-5766
Practice Address - Fax:520-325-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty