Provider Demographics
NPI:1710181748
Name:GENERATIONS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:GENERATIONS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HALLUMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:480-206-4264
Mailing Address - Street 1:4960 S GILBERT RD
Mailing Address - Street 2:SUITE 1-496
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5982
Mailing Address - Country:US
Mailing Address - Phone:480-917-2745
Mailing Address - Fax:
Practice Address - Street 1:2200 E WILLIAMS FIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0761
Practice Address - Country:US
Practice Address - Phone:480-320-2304
Practice Address - Fax:888-243-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55802251P0200X
AZTSLP5625235Z00000X
AZSLP0332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1275552465OtherINDIVIUAL NPI
AZ741662OtherINDIVIDUAL AHCCCS
AZ1275552465OtherINDIVIUAL NPI