Organization
AGE VICTORIOUSLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW D ESSEX (MANAGER)
(602) 741-6739
Entity
Organization
Contact information
Practice address
7880 SAN FELIPE ST STE 200, HOUSTON, TX 77063-1608
(832) 377-5968
Mailing address
2753 E TAMARISK ST, GILBERT, AZ 85296-8997
(602) 741-6739
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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