Provider Demographics
NPI:1619974052
Name:ENDURANCE REHABILITATION LLC
Entity Type:Organization
Organization Name:ENDURANCE REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:QUINTEN
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:480-556-8406
Mailing Address - Street 1:9376 E BAHIA DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1532
Mailing Address - Country:US
Mailing Address - Phone:480-556-8406
Mailing Address - Fax:480-607-5840
Practice Address - Street 1:9376 E BAHIA DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1532
Practice Address - Country:US
Practice Address - Phone:480-556-8406
Practice Address - Fax:480-607-5840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103545Medicare PIN
AZZ103545Medicare PIN