Provider Demographics
NPI:1154391175
Name:KITCHEN, JEFF D (PT)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:D
Last Name:KITCHEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18607
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85269-8607
Mailing Address - Country:US
Mailing Address - Phone:480-415-0444
Mailing Address - Fax:480-419-3522
Practice Address - Street 1:10121 E BELL RD
Practice Address - Street 2:140
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2189
Practice Address - Country:US
Practice Address - Phone:480-419-3500
Practice Address - Fax:480-419-3522
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ2214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ969371Medicaid
AZZ106348OtherMEDICARE LEGACY
AZ2Z0057OtherHEALTHNET
AZZ106347OtherMEDICARE LEGACY GROUP
AZ0461600OtherBCBS
AZ7228691OtherAETNA