Provider Demographics
NPI:1780741116
Name:EXCLUSIVELY SPINE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:EXCLUSIVELY SPINE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HOURIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:623-776-7577
Mailing Address - Street 1:7616 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6081
Mailing Address - Country:US
Mailing Address - Phone:623-776-7577
Mailing Address - Fax:623-776-7597
Practice Address - Street 1:7616 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-6081
Practice Address - Country:US
Practice Address - Phone:623-776-7577
Practice Address - Fax:623-776-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4405OtherSTATE LICENSE