Provider Demographics
NPI:1811226103
Name:ACHIEVE PHYSICAL THERAPY OF ARIZONA, PLLC
Entity Type:Organization
Organization Name:ACHIEVE PHYSICAL THERAPY OF ARIZONA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:623-201-7210
Mailing Address - Street 1:17235 N 75TH AVE STE E145
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0867
Mailing Address - Country:US
Mailing Address - Phone:623-201-7210
Mailing Address - Fax:623-201-7214
Practice Address - Street 1:17235 N 75TH AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:602-314-2747
Practice Address - Fax:602-314-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty