Provider Demographics
NPI:1124160734
Name:SUNNY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SUNNY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:928-542-3233
Mailing Address - Street 1:PO BOX 5474
Mailing Address - Street 2:
Mailing Address - City:MOHAVE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86446-5474
Mailing Address - Country:US
Mailing Address - Phone:928-542-3233
Mailing Address - Fax:928-788-4232
Practice Address - Street 1:8450 OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MOHAVE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86440-9214
Practice Address - Country:US
Practice Address - Phone:928-768-2507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ968919OtherAHCCCS ID NUMBER