Provider Demographics
NPI:1639472244
Name:GILBERT PT, LLC
Entity Type:Organization
Organization Name:GILBERT PT, LLC
Other - Org Name:PAIN ASSOCIATES OF GILBERT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:EBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-679-7676
Mailing Address - Street 1:3004 N CIVIC CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6904
Mailing Address - Country:US
Mailing Address - Phone:480-990-7676
Mailing Address - Fax:480-990-8222
Practice Address - Street 1:610 N GILBERT RD
Practice Address - Street 2:SUITE 309
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4502
Practice Address - Country:US
Practice Address - Phone:480-926-1111
Practice Address - Fax:480-926-2958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7280111N00000X
AZ27848207LP2900X
AZAP3957363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty