Provider Demographics
NPI:1609118181
Name:ARIZONA COOPERATIVE THERAPIES
Entity Type:Organization
Organization Name:ARIZONA COOPERATIVE THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HUPPERT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:602-547-1111
Mailing Address - Street 1:99 E. VIRGINIA AVENUE
Mailing Address - Street 2:STE. 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004
Mailing Address - Country:US
Mailing Address - Phone:602-547-1111
Mailing Address - Fax:602-296-0226
Practice Address - Street 1:99 E. VIRGINIA AVENUE
Practice Address - Street 2:STE. 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004
Practice Address - Country:US
Practice Address - Phone:602-547-1111
Practice Address - Fax:602-296-0226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA COOPERATIVE THERAPIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-21
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4306225X00000X
AZ225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty