Provider Demographics
NPI:1881993996
Name:NORTHERN ARIZONA PHYSICAL THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:NORTHERN ARIZONA PHYSICAL THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIJKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUPACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-301-1977
Mailing Address - Street 1:2530 W STATE ROUTE 89A
Mailing Address - Street 2:B-1
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5256
Mailing Address - Country:US
Mailing Address - Phone:928-282-3950
Mailing Address - Fax:928-282-6990
Practice Address - Street 1:2530 W STATE ROUTE 89A
Practice Address - Street 2:B-1
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5256
Practice Address - Country:US
Practice Address - Phone:928-282-3950
Practice Address - Fax:928-282-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZZ146505261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ619866Medicaid
AZZ146505Medicare PIN