Provider Demographics
NPI:1457399073
Name:ARIZONA MANUAL THERAPY CENTERS PLLC
Entity type:Organization
Organization Name:ARIZONA MANUAL THERAPY CENTERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:THRAEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-629-4606
Mailing Address - Street 1:16700 N THOMPSON PEAK PKWY
Mailing Address - Street 2:STE 220
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2384
Mailing Address - Country:US
Mailing Address - Phone:480-629-4606
Mailing Address - Fax:480-629-8511
Practice Address - Street 1:16700 N THOMPSON PEAK PKWY
Practice Address - Street 2:STE 220
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2384
Practice Address - Country:US
Practice Address - Phone:480-629-4606
Practice Address - Fax:480-629-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ07152Medicaid