Provider Demographics
NPI:1184470692
Name:CAVE CREEK PEDIATRIC THERAPY
Entity type:Organization
Organization Name:CAVE CREEK PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-670-7676
Mailing Address - Street 1:32042 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5524
Mailing Address - Country:US
Mailing Address - Phone:602-670-7676
Mailing Address - Fax:
Practice Address - Street 1:32042 N 52ND ST
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5524
Practice Address - Country:US
Practice Address - Phone:602-670-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech