Provider Demographics
NPI:1023683182
Name:PRESCOTT MOBILE PHYSICAL THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:PRESCOTT MOBILE PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-614-2801
Mailing Address - Street 1:6421 E MARLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-3871
Mailing Address - Country:US
Mailing Address - Phone:602-614-2801
Mailing Address - Fax:
Practice Address - Street 1:6421 E MARLEY AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-3871
Practice Address - Country:US
Practice Address - Phone:602-614-2801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy