Provider Demographics
NPI:1801202031
Name:ARIZONA THERAPY SQUAD, LLC
Entity Type:Organization
Organization Name:ARIZONA THERAPY SQUAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:STROM
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:928-607-0441
Mailing Address - Street 1:4410 W UNION HILLS DR
Mailing Address - Street 2:STE 7-272
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1660
Mailing Address - Country:US
Mailing Address - Phone:928-607-0441
Mailing Address - Fax:602-926-8252
Practice Address - Street 1:4410 W UNION HILLS DR
Practice Address - Street 2:STE 7-272
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1660
Practice Address - Country:US
Practice Address - Phone:928-607-0441
Practice Address - Fax:602-926-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP7638251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health