Provider Demographics
NPI:1558391714
Name:CENTRAL ARIZONA THERAPY LLC
Entity Type:Organization
Organization Name:CENTRAL ARIZONA THERAPY LLC
Other - Org Name:CENTRAL AZ THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWLUS
Authorized Official - Suffix:
Authorized Official - Credentials:OT L
Authorized Official - Phone:928-567-7330
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-0640
Mailing Address - Country:US
Mailing Address - Phone:928-567-7330
Mailing Address - Fax:928-567-4146
Practice Address - Street 1:513 S AZURE DR.
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322
Practice Address - Country:US
Practice Address - Phone:928-567-7330
Practice Address - Fax:928-567-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ556003174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty