Provider Demographics
NPI:1487751772
Name:AFFINITY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:AFFINITY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HUMPHREYS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-868-0098
Mailing Address - Street 1:PO BOX 1431
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85232-1431
Mailing Address - Country:US
Mailing Address - Phone:520-868-0098
Mailing Address - Fax:520-868-1098
Practice Address - Street 1:448 E. BUTTE
Practice Address - Street 2:SUITE 3
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232-1431
Practice Address - Country:US
Practice Address - Phone:520-868-0098
Practice Address - Fax:520-868-1098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5881174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty