Provider Demographics
NPI:1740873835
Name:GUIDANCE PHYSICAL THERAPY & WELLNESS, PLLC
Entity type:Organization
Organization Name:GUIDANCE PHYSICAL THERAPY & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-291-7001
Mailing Address - Street 1:605 W ECHO LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5795
Mailing Address - Country:US
Mailing Address - Phone:602-291-7001
Mailing Address - Fax:
Practice Address - Street 1:605 W ECHO LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5795
Practice Address - Country:US
Practice Address - Phone:602-291-7001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy