Provider Demographics
NPI:1790133916
Name:TRANSFORM MANUAL PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:TRANSFORM MANUAL PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RONDINA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:602-616-5899
Mailing Address - Street 1:9376 E BAHIA DR
Mailing Address - Street 2:STE D101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1532
Mailing Address - Country:US
Mailing Address - Phone:602-616-5899
Mailing Address - Fax:
Practice Address - Street 1:9376 E BAHIA DR
Practice Address - Street 2:STE D101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1532
Practice Address - Country:US
Practice Address - Phone:602-616-5899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5518261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy