Provider Demographics
NPI:1689611584
Name:CAMELBACK PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:CAMELBACK PHYSICAL THERAPY, LLC
Other - Org Name:CAMELBACK THERAPY ASSOCIATES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HALLIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-230-7784
Mailing Address - Street 1:2020 W. CHIMNEY ROCK RD.
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:602-230-7784
Mailing Address - Fax:602-230-0145
Practice Address - Street 1:2020 W. CHIMNEY ROCK RD.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085
Practice Address - Country:US
Practice Address - Phone:602-230-7784
Practice Address - Fax:602-230-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ147117OtherACCHS
AZTC00831OtherTRICARE
AZ0297370OtherBCBS
AZTC00831OtherTRICARE