Provider Demographics
NPI:1912095936
Name:EAST VALLEY PHYSICAL THERAPY & AQUATIC REHABILITATION LTD
Entity Type:Organization
Organization Name:EAST VALLEY PHYSICAL THERAPY & AQUATIC REHABILITATION LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-981-0900
Mailing Address - Street 1:217 S 63RD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6106
Mailing Address - Country:US
Mailing Address - Phone:480-981-0900
Mailing Address - Fax:480-981-0897
Practice Address - Street 1:217 S 63RD ST STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6106
Practice Address - Country:US
Practice Address - Phone:480-981-0900
Practice Address - Fax:480-981-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ29310Medicare UPIN