Provider Demographics
NPI:1396758868
Name:GIFFORD, CHARLES T (PT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:T
Last Name:GIFFORD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:42211 N 41ST DR
Mailing Address - Street 2:SUITE 169
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3810
Mailing Address - Country:US
Mailing Address - Phone:623-742-7338
Mailing Address - Fax:623-742-7339
Practice Address - Street 1:42211 N 41ST DR
Practice Address - Street 2:SUITE 169
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3810
Practice Address - Country:US
Practice Address - Phone:623-742-7338
Practice Address - Fax:623-742-7339
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ113537Medicare PIN