Provider Demographics
NPI:1134582851
Name:DESERT REHAB LLC
Entity type:Organization
Organization Name:DESERT REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:H
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:928-651-2698
Mailing Address - Street 1:2622 CABO BURELA DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-4284
Mailing Address - Country:US
Mailing Address - Phone:928-651-2698
Mailing Address - Fax:
Practice Address - Street 1:222 E FRY BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-1817
Practice Address - Country:US
Practice Address - Phone:520-459-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10765261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy