Provider Demographics
NPI:1578592705
Name:KC'S PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:KC'S PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HALCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-237-5047
Mailing Address - Street 1:20612 N CAVE CREEK RD # F151
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-4440
Mailing Address - Country:US
Mailing Address - Phone:602-237-5047
Mailing Address - Fax:602-237-5522
Practice Address - Street 1:20612 N CAVE CREEK RD # F151
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4440
Practice Address - Country:US
Practice Address - Phone:602-237-5047
Practice Address - Fax:602-237-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ32382251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ920795Medicaid
AZ920795Medicaid