Provider Demographics
NPI:1932439031
Name:PHYSICAL THERAPY OF TEMPE
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF TEMPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-755-7868
Mailing Address - Street 1:1030 E BASELINE RD STE 178
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1371
Mailing Address - Country:US
Mailing Address - Phone:480-755-7868
Mailing Address - Fax:480-755-7871
Practice Address - Street 1:1030 E BASELINE RD STE 178
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1371
Practice Address - Country:US
Practice Address - Phone:480-755-7868
Practice Address - Fax:480-755-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6614261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy