Provider Demographics
NPI:1730309204
Name:JEFF KITCHEN, INC.
Entity Type:Organization
Organization Name:JEFF KITCHEN, INC.
Other - Org Name:REHAB PLUS SPORTS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:KITCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:480-415-0444
Mailing Address - Street 1:PO BOX 18607
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85269-8607
Mailing Address - Country:US
Mailing Address - Phone:480-415-0444
Mailing Address - Fax:480-419-3522
Practice Address - Street 1:10121 E BELL RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2187
Practice Address - Country:US
Practice Address - Phone:480-419-3500
Practice Address - Fax:480-419-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ2214225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0461600OtherBCBS AZ NUMBER
AZ2Z0057OtherHEALTHNET PROVIDER NUMBER
AZ7228691OtherAETNA PROVIDER NUMBER
AZ969371Medicaid
AZ7228691OtherAETNA PROVIDER NUMBER