Provider Demographics
NPI:1649485269
Name:DESERT VIEW PHYSICAL THERAPY
Entity type:Organization
Organization Name:DESERT VIEW PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:MIKKEL
Authorized Official - Last Name:BRATRUD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-396-9020
Mailing Address - Street 1:6641 E BAYWOOD AVE
Mailing Address - Street 2:SUITE A 4
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1723
Mailing Address - Country:US
Mailing Address - Phone:480-396-9020
Mailing Address - Fax:480-218-9182
Practice Address - Street 1:6641 E BAYWOOD AVE
Practice Address - Street 2:SUITE A 4
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1723
Practice Address - Country:US
Practice Address - Phone:480-396-9020
Practice Address - Fax:480-218-9182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment