Provider Demographics
NPI:1811439029
Name:PINNACLE SPORTS THERAPY LLC.
Entity type:Organization
Organization Name:PINNACLE SPORTS THERAPY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-283-3360
Mailing Address - Street 1:425 E PINNACLE PEAK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-5657
Mailing Address - Country:US
Mailing Address - Phone:602-283-3360
Mailing Address - Fax:602-283-3361
Practice Address - Street 1:425 E PINNACLE PEAK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-5657
Practice Address - Country:US
Practice Address - Phone:602-283-3360
Practice Address - Fax:602-283-3361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-06
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8092261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1275584567OtherNPI