Provider Demographics
NPI:1023072659
Name:SERVICE FIRST PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:SERVICE FIRST PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:HALLING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-510-4800
Mailing Address - Street 1:PO BOX 22053
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4951
Mailing Address - Country:US
Mailing Address - Phone:602-510-4800
Mailing Address - Fax:602-652-0133
Practice Address - Street 1:3226 E LAZY LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4951
Practice Address - Country:US
Practice Address - Phone:602-510-4800
Practice Address - Fax:602-652-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035439Medicaid
AZ102206Medicare ID - Type Unspecified