Provider Demographics
NPI:1306267703
Name:MISSION HILL GROUP LLC
Entity type:Organization
Organization Name:MISSION HILL GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JARED
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:480-298-1846
Mailing Address - Street 1:3321 E QUEEN CREEK RD
Mailing Address - Street 2:#106
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-8530
Mailing Address - Country:US
Mailing Address - Phone:480-550-9100
Mailing Address - Fax:480-550-9100
Practice Address - Street 1:3321 E QUEEN CREEK RD
Practice Address - Street 2:#106
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8530
Practice Address - Country:US
Practice Address - Phone:480-550-9100
Practice Address - Fax:480-550-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ93502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1447339304OtherNPI
18081OtherBOARD-CERTIFIED ORTHOPEDIC SPECIALIST (OCS)
AZ624670Medicaid
AZZ167507Medicare PIN