Organization
CTB AZ, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MASENGALE (OWNER)
(602) 318-2041
Entity
Organization
Contact information
Practice address
2075 S COTTONWOOD DR, TEMPE, AZ 85282-3040
(602) 318-2041
Mailing address
2401 W SOUTHERN AVE LOT 462, TEMPE, AZ 85282-4342
(602) 318-2041
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
08/21/2020
Last updated
08/21/2020
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