Provider Demographics
NPI:1780009621
Name:VALLEY VIEW PHYSICIAN PRACTICES, LLC
Entity Type:Organization
Organization Name:VALLEY VIEW PHYSICIAN PRACTICES, LLC
Other - Org Name:VALLEY VIEW PHYSICAL MEDICINE AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:5300 S. HIGHWAY 95
Mailing Address - Street 2:STE. D
Mailing Address - City:FT. MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426
Mailing Address - Country:US
Mailing Address - Phone:928-788-3609
Mailing Address - Fax:928-788-3607
Practice Address - Street 1:5300 S. HIGHWAY 95
Practice Address - Street 2:STE. D.
Practice Address - City:FT. MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426
Practice Address - Country:US
Practice Address - Phone:928-788-3609
Practice Address - Fax:928-788-3607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-02
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
AZ33446208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ128746Medicare PIN