Provider Demographics
NPI:1871751347
Name:SOUTHWEST PHYSICAL THERAPY AND REHAB LLC
Entity type:Organization
Organization Name:SOUTHWEST PHYSICAL THERAPY AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIRTI
Authorized Official - Middle Name:MINESH
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-876-9064
Mailing Address - Street 1:1760 E FLORENCE BLVD
Mailing Address - Street 2:SUITE #150
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-4764
Mailing Address - Country:US
Mailing Address - Phone:520-876-9064
Mailing Address - Fax:520-876-9145
Practice Address - Street 1:1760 E FLORENCE BLVD
Practice Address - Street 2:SUITE #150
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4764
Practice Address - Country:US
Practice Address - Phone:520-876-9064
Practice Address - Fax:520-876-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty