Provider Demographics
NPI:1861820508
Name:IGNITE PHYSICAL THERAPY PLC
Entity Type:Organization
Organization Name:IGNITE PHYSICAL THERAPY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:POLONI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:845-642-4207
Mailing Address - Street 1:3970 E RIGGS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5412
Mailing Address - Country:US
Mailing Address - Phone:480-883-0202
Mailing Address - Fax:
Practice Address - Street 1:3970 E RIGGS RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5412
Practice Address - Country:US
Practice Address - Phone:480-883-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty