Provider Demographics
NPI:1295252096
Name:FAITH PHYSICAL THERAPY
Entity type:Organization
Organization Name:FAITH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-290-4014
Mailing Address - Street 1:5129 E FERNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-2306
Mailing Address - Country:US
Mailing Address - Phone:480-290-4014
Mailing Address - Fax:
Practice Address - Street 1:5129 E FERNWOOD CT
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-2306
Practice Address - Country:US
Practice Address - Phone:480-290-4014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty