Provider Demographics
NPI:1649565474
Name:PEPENELLI, PATRICK V (PT DPT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:V
Last Name:PEPENELLI
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2849
Mailing Address - Country:US
Mailing Address - Phone:480-234-7100
Mailing Address - Fax:
Practice Address - Street 1:4475 E KNOX RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4400
Practice Address - Country:US
Practice Address - Phone:480-893-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021286225100000X
VA2305208435225100000X
AZ11169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist