Provider Demographics
NPI:1740239441
Name:GREENWALD, ESTHER N (PT)
Entity Type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:N
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 W IRON SPRINGS RD
Mailing Address - Street 2:101
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3313
Mailing Address - Country:US
Mailing Address - Phone:928-778-7929
Mailing Address - Fax:928-778-7929
Practice Address - Street 1:1680 W IRON SPRINGS RD
Practice Address - Street 2:101
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3313
Practice Address - Country:US
Practice Address - Phone:928-778-7929
Practice Address - Fax:928-778-7929
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3319225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0462680OtherBCBS
P46799Medicare UPIN
AZ0462680OtherBCBS