Provider Demographics
NPI:1932315348
Name:AMAZING ABILITIES THERAPIES
Entity Type:Organization
Organization Name:AMAZING ABILITIES THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:623-875-0419
Mailing Address - Street 1:8924 N 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7306
Mailing Address - Country:US
Mailing Address - Phone:623-875-0419
Mailing Address - Fax:623-388-3242
Practice Address - Street 1:8924 N 104TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7306
Practice Address - Country:US
Practice Address - Phone:623-875-0419
Practice Address - Fax:623-388-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1493174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ894594Medicare ID - Type UnspecifiedARIZONA COST CONTAINMENT