Provider Demographics
NPI:1790735835
Name:METRO PHYSICAL THERAPY - GLENDALE, LLC
Entity Type:Organization
Organization Name:METRO PHYSICAL THERAPY - GLENDALE, LLC
Other - Org Name:METRO PHYSICAL THERAPY ARROWHEAD, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-776-9111
Mailing Address - Street 1:17431 N 71ST DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8598
Mailing Address - Country:US
Mailing Address - Phone:623-776-9111
Mailing Address - Fax:623-776-9115
Practice Address - Street 1:17431 N 71ST DR
Practice Address - Street 2:SUITE 104
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8598
Practice Address - Country:US
Practice Address - Phone:623-776-9111
Practice Address - Fax:623-776-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ109212Medicare PIN