Provider Demographics
NPI:1932727559
Name:SUN CITY PERFORMING ARTS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:SUN CITY PERFORMING ARTS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST. OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:CAROLINA
Authorized Official - Last Name:NAVARRETE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:915-329-6659
Mailing Address - Street 1:7716 MAPLE LANDING CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7199
Mailing Address - Country:US
Mailing Address - Phone:915-329-6659
Mailing Address - Fax:
Practice Address - Street 1:7716 MAPLE LANDING CT
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7199
Practice Address - Country:US
Practice Address - Phone:915-329-6659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare