Provider Demographics
NPI:1538694104
Name:PARAGON PHYSICAL THERAPY AND REHAB, LLC
Entity Type:Organization
Organization Name:PARAGON PHYSICAL THERAPY AND REHAB, LLC
Other - Org Name:PARAGON HEALTHCARE OF ARIZONA, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LINVILLE-PETRIK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-444-8168
Mailing Address - Street 1:2585 MIRACLE MILE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7522
Mailing Address - Country:US
Mailing Address - Phone:928-444-8168
Mailing Address - Fax:928-444-8169
Practice Address - Street 1:2585 MIRACLE MILE
Practice Address - Street 2:SUITE 107
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7522
Practice Address - Country:US
Practice Address - Phone:928-444-8168
Practice Address - Fax:928-444-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy