Provider Demographics
NPI:1003933458
Name:DENNIS R. ST JAMES PHYSICAL THERAPY LTD
Entity type:Organization
Organization Name:DENNIS R. ST JAMES PHYSICAL THERAPY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ST JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-266-9922
Mailing Address - Street 1:532 E MARYLAND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1143
Mailing Address - Country:US
Mailing Address - Phone:602-266-9922
Mailing Address - Fax:602-266-6533
Practice Address - Street 1:532 E MARYLAND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1143
Practice Address - Country:US
Practice Address - Phone:602-266-9922
Practice Address - Fax:602-266-6533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRPT785Medicare ID - Type Unspecified