Provider Demographics
NPI:1447629787
Name:DEMEULENAERE, EMILY ROSE (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ROSE
Last Name:DEMEULENAERE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 N 36TH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3588
Mailing Address - Country:US
Mailing Address - Phone:602-956-4040
Mailing Address - Fax:
Practice Address - Street 1:4440 N 36TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3588
Practice Address - Country:US
Practice Address - Phone:602-956-4040
Practice Address - Fax:602-956-4011
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist