Provider Demographics
NPI:1710105747
Name:SAN TAN PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:SAN TAN PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-677-2771
Mailing Address - Street 1:20261 E OCOTILLO RD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8806
Mailing Address - Country:US
Mailing Address - Phone:480-677-2771
Mailing Address - Fax:480-677-2768
Practice Address - Street 1:20261 E OCOTILLO RD
Practice Address - Street 2:SUITE #110
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-8806
Practice Address - Country:US
Practice Address - Phone:480-677-2771
Practice Address - Fax:480-677-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ107798Medicare UPIN