Provider Demographics
NPI:1609105931
Name:PHYSICAL THERAPY OF SONOITA
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF SONOITA
Other - Org Name:BRIDGETT MEYERS MPT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEYERS GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:520-455-5439
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:SONOITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85637-0776
Mailing Address - Country:US
Mailing Address - Phone:520-455-5439
Mailing Address - Fax:520-455-5439
Practice Address - Street 1:50 SHERWOOD FOREST LANE
Practice Address - Street 2:
Practice Address - City:SONOITA
Practice Address - State:AZ
Practice Address - Zip Code:85637
Practice Address - Country:US
Practice Address - Phone:520-455-5439
Practice Address - Fax:520-455-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ27645Medicare PIN