Provider Demographics
NPI:1124057666
Name:NORTHLAND THERAPY SERVICES INC
Entity type:Organization
Organization Name:NORTHLAND THERAPY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-532-1532
Mailing Address - Street 1:1294 FAWNBROOK DRIVE
Mailing Address - Street 2:PO BOX 328
Mailing Address - City:SHOWLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85902
Mailing Address - Country:US
Mailing Address - Phone:928-532-1532
Mailing Address - Fax:928-532-1538
Practice Address - Street 1:1294 FAWNBROOK DRIVE
Practice Address - Street 2:
Practice Address - City:SHOWLOW
Practice Address - State:AZ
Practice Address - Zip Code:85902
Practice Address - Country:US
Practice Address - Phone:928-532-1532
Practice Address - Fax:928-532-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ954306Medicaid
AZAZ0463850OtherBCBS