Organization
PETKOV BODYWORK THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUMEN PETKOV OTR/L (BUSINESS OWNER)
(651) 442-5094
Entity
Organization
Contact information
Practice address
5168 W AUGUSTA AVE, GLENDALE, AZ 85301-1469
(480) 269-5029
(480) 389-3047
Mailing address
5168 W AUGUSTA AVE, GLENDALE, AZ 85301-1469
(480) 269-5029
(480) 389-3047
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245613553
NPI
AZ
Enumeration date
03/25/2020
Last updated
08/23/2021
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