Provider Demographics
NPI:1386131837
Name:PLACES YOU'LL GO THERAPY LLC
Entity type:Organization
Organization Name:PLACES YOU'LL GO THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WICUS
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L, BCP
Authorized Official - Phone:480-910-0372
Mailing Address - Street 1:3241 E SHEA BLVD STE 1-503
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3335
Mailing Address - Country:US
Mailing Address - Phone:480-910-0372
Mailing Address - Fax:
Practice Address - Street 1:3241 E SHEA BLVD
Practice Address - Street 2:STE 1-503
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3365
Practice Address - Country:US
Practice Address - Phone:480-910-2772
Practice Address - Fax:480-718-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty