Provider Demographics
NPI:1801941992
Name:TRUE REHAB OF ARIZONA,LLC
Entity type:Organization
Organization Name:TRUE REHAB OF ARIZONA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-453-0501
Mailing Address - Street 1:1720 MESQUITE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5602
Mailing Address - Country:US
Mailing Address - Phone:928-453-0501
Mailing Address - Fax:928-453-0502
Practice Address - Street 1:297 LAKE HAVASU AVE S STE 102
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6526
Practice Address - Country:US
Practice Address - Phone:928-453-0501
Practice Address - Fax:928-453-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3718261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy