Provider Demographics
NPI:1982637252
Name:PRO HEALTH THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:PRO HEALTH THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:T
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:602-206-7687
Mailing Address - Street 1:644 W COMSTOCK DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5804
Mailing Address - Country:US
Mailing Address - Phone:602-206-7687
Mailing Address - Fax:480-813-0489
Practice Address - Street 1:644 W COMSTOCK DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5804
Practice Address - Country:US
Practice Address - Phone:602-206-7687
Practice Address - Fax:480-813-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2274251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health