Provider Demographics
NPI:1851859664
Name:DISTINCT PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:DISTINCT PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:480-887-8725
Mailing Address - Street 1:900 W CHANDLER BLVD STE A-4
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4908
Mailing Address - Country:US
Mailing Address - Phone:480-887-8725
Mailing Address - Fax:480-719-1531
Practice Address - Street 1:900 W CHANDLER BLVD STE A-4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4908
Practice Address - Country:US
Practice Address - Phone:480-887-8725
Practice Address - Fax:480-719-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty