Provider Demographics
NPI:1831388388
Name:DESERT SUN PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:DESERT SUN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-361-4604
Mailing Address - Street 1:454 W HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3973
Mailing Address - Country:US
Mailing Address - Phone:480-361-4604
Mailing Address - Fax:480-237-9474
Practice Address - Street 1:1807 E QUEEN CREEK RD
Practice Address - Street 2:SUITE 7
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2024
Practice Address - Country:US
Practice Address - Phone:480-361-4604
Practice Address - Fax:480-237-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6089261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ118520Medicare PIN