Basic Information
| Provider Information | |||||||||
| NPI: | 1457399073 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA MANUAL THERAPY CENTERS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16700 N THOMPSON PEAK PKWY | ||||||||
| Address2: | STE 220 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852602384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806294606 | ||||||||
| FaxNumber: | 4806298511 | ||||||||
| Practice Location | |||||||||
| Address1: | 16700 N THOMPSON PEAK PKWY | ||||||||
| Address2: | STE 220 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852602384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806294606 | ||||||||
| FaxNumber: | 4806298511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 01/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | THRAEN | ||||||||
| AuthorizedOfficialFirstName: | RILEY | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4806294606 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 01/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3300 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | AZ07152 | 05 | AZ | MEDICAID |