Provider Demographics
NPI:1336149723
Name:CACTUS PHYSICAL THERAPY LIMITED, INC.
Entity Type:Organization
Organization Name:CACTUS PHYSICAL THERAPY LIMITED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P./SECRETARY & STATUTORY AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAINCHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:623-465-7653
Mailing Address - Street 1:PO BOX 5914
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-5914
Mailing Address - Country:US
Mailing Address - Phone:623-465-7653
Mailing Address - Fax:623-465-7653
Practice Address - Street 1:34155 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-1221
Practice Address - Country:US
Practice Address - Phone:480-488-7018
Practice Address - Fax:623-465-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ #617208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0088730OtherBCBS AZ
AR617OtherAZ PT
AZ19070617OtherI.C.A.
AZAZ0088730OtherBCBS AZ
AR617OtherAZ PT