Provider Demographics
NPI:1194886556
Name:ENDURANCE REHABILITATION LLC
Entity type:Organization
Organization Name:ENDURANCE REHABILITATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-556-8406
Mailing Address - Street 1:4440 N 36TH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3588
Mailing Address - Country:US
Mailing Address - Phone:602-956-4040
Mailing Address - Fax:602-956-4011
Practice Address - Street 1:4440 N 36TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3588
Practice Address - Country:US
Practice Address - Phone:602-956-4040
Practice Address - Fax:602-956-4011
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENDURANCE REHABILITATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-12
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112355Medicare PIN
AZZ112355Medicare PIN