Basic Information
| Provider Information | |||||||||
| NPI: | 1093750762 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DESERT VIEW PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6641 E BAYWOOD AVE | ||||||||
| Address2: | SUITE A4 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803699020 | ||||||||
| FaxNumber: | 4802189182 | ||||||||
| Practice Location | |||||||||
| Address1: | 6641 E BAYWOOD AVE | ||||||||
| Address2: | SUITE A4 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803699020 | ||||||||
| FaxNumber: | 4802189182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRATRUD | ||||||||
| AuthorizedOfficialFirstName: | RANDY | ||||||||
| AuthorizedOfficialMiddleName: | MIKKEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4803969020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.