Provider Demographics
NPI:1306916366
Name:EAST MESA PHYSICAL THERAPY AND REHAB SPECIALISTS
Entity type:Organization
Organization Name:EAST MESA PHYSICAL THERAPY AND REHAB SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRIAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-552-2996
Mailing Address - Street 1:8700 DURAND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177
Mailing Address - Country:US
Mailing Address - Phone:877-552-2996
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:736 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-4936
Practice Address - Country:US
Practice Address - Phone:877-552-2996
Practice Address - Fax:866-245-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
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
AZ75453Medicare ID - Type Unspecified