Provider Demographics
NPI:1871559658
Name:THERASPORT LLC
Entity type:Organization
Organization Name:THERASPORT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-596-3371
Mailing Address - Street 1:15950 N 76TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1882
Mailing Address - Country:US
Mailing Address - Phone:480-596-3371
Mailing Address - Fax:480-596-3849
Practice Address - Street 1:15950 N 76TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1882
Practice Address - Country:US
Practice Address - Phone:480-596-3371
Practice Address - Fax:480-596-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5194022OtherAETNA
AZ1702610OtherUNITED
AZAZ0294640OtherBLUE CROSS BLUE SHIELD
AZZ101157OtherMEDICARE
AZ1Z3060OtherHEALTH NET
AZ1Z3060OtherHEALTH NET