Provider Demographics
NPI:1851575674
Name:DESERT PHYSICAL THERAPY & WOMEN'S HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:DESERT PHYSICAL THERAPY & WOMEN'S HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-264-3369
Mailing Address - Street 1:4545 E SHEA BLVD
Mailing Address - Street 2:SUITE 168
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3074
Mailing Address - Country:US
Mailing Address - Phone:602-264-3369
Mailing Address - Fax:602-264-3368
Practice Address - Street 1:4545 E SHEA BLVD
Practice Address - Street 2:SUITE 168
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3074
Practice Address - Country:US
Practice Address - Phone:602-264-3369
Practice Address - Fax:602-264-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6451261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy