Basic Information
| Provider Information | |||||||||
| NPI: | 1083290209 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | L2E PHYSICAL THERAPY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17440 N 34TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850536607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736319953 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16165 N 83RD AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853825816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736319953 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2021 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | BRIANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5736319953 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT, FAFS | ||||||||
| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.