Provider Demographics
NPI:1205890134
Name:RESOURCE PHYSICAL THERAPY
Entity type:Organization
Organization Name:RESOURCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:DUMYAHN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-639-3068
Mailing Address - Street 1:PO BOX 2024
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2024
Mailing Address - Country:US
Mailing Address - Phone:928-634-0665
Mailing Address - Fax:928-634-0337
Practice Address - Street 1:825 W MINGUS AVE
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4088
Practice Address - Country:US
Practice Address - Phone:928-639-3068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ65189Medicare ID - Type Unspecified