Provider Demographics
NPI:1851490627
Name:ARIZONA ORTHOPEDIC PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:ARIZONA ORTHOPEDIC PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RYANN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:623-242-6908
Mailing Address - Street 1:14557 W INDIAN SCHOOL RD
Mailing Address - Street 2:# 500
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9243
Mailing Address - Country:US
Mailing Address - Phone:623-242-6908
Mailing Address - Fax:623-242-6909
Practice Address - Street 1:14557 W INDIAN SCHOOL RD
Practice Address - Street 2:# 500
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9243
Practice Address - Country:US
Practice Address - Phone:623-242-6908
Practice Address - Fax:623-242-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNOT REQUIRED261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ111938Medicare PIN