Basic Information
| Provider Information | |||||||||
| NPI: | 1649485269 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DESERT VIEW PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6641 E BAYWOOD AVE | ||||||||
| Address2: | SUITE A 4 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803969020 | ||||||||
| FaxNumber: | 4802189182 | ||||||||
| Practice Location | |||||||||
| Address1: | 6641 E BAYWOOD AVE | ||||||||
| Address2: | SUITE A 4 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803969020 | ||||||||
| FaxNumber: | 4802189182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRATRUD | ||||||||
| AuthorizedOfficialFirstName: | RANDY | ||||||||
| AuthorizedOfficialMiddleName: | MIKKEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4803969020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | X | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | X | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.