Organization
PHYSICAL THERAPY CLINIC OF GOLD CANYON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DARLENE MARIE CHURCHMAN (OFFICE MANAGER)
(480) 983-2259
Entity
Organization
Contact information
Practice address
6410 S KINGS RANCH RD, SUITE 2, GOLD CANYON, AZ 85118-7352
(480) 983-2259
(480) 983-2259
Mailing address
6410 S KINGS RANCH RD, SUITE 2, GOLD CANYON, AZ 85118-7352
(480) 983-2259
(480) 983-2259
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
378
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
670001707
RAIL ROAD MEDICARE
AZ
01
—
AZ0292230
BLUE CROSS/BLUE SHIELD
AZ
Enumeration date
08/23/2007
Last updated
10/02/2009
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