Provider Demographics
NPI:1386721512
Name:NEUROLOGIC THERAPY SPECIALISTS LLC
Entity type:Organization
Organization Name:NEUROLOGIC THERAPY SPECIALISTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BONAROTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-277-1073
Mailing Address - Street 1:5017 E WASHINGTON ST # 107A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-2033
Mailing Address - Country:US
Mailing Address - Phone:602-277-1073
Mailing Address - Fax:602-277-1016
Practice Address - Street 1:5017 E WASHINGTON ST # 107A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2033
Practice Address - Country:US
Practice Address - Phone:602-277-1073
Practice Address - Fax:602-277-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
AZ6092261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation