Provider Demographics
NPI:1902856172
Name:METRO PHYSICAL THERAPY OF SURPRISE
Entity Type:Organization
Organization Name:METRO PHYSICAL THERAPY OF SURPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-209-5066
Mailing Address - Street 1:7200 W BELL RD
Mailing Address - Street 2:SUITE F-101
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8529
Mailing Address - Country:US
Mailing Address - Phone:623-776-9111
Mailing Address - Fax:623-776-9115
Practice Address - Street 1:15288 W BROOKSIDE LN
Practice Address - Street 2:SUITE 131
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3990
Practice Address - Country:US
Practice Address - Phone:623-537-9882
Practice Address - Fax:623-537-9885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ109731Medicare PIN