Provider Demographics
NPI:1427334028
Name:FOUNDATIONAL PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:FOUNDATIONAL PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:480-786-4969
Mailing Address - Street 1:5590 W CHANDLER BLVD
Mailing Address - Street 2:BLDG B STE 4
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3697
Mailing Address - Country:US
Mailing Address - Phone:480-786-4969
Mailing Address - Fax:480-786-5118
Practice Address - Street 1:5590 W CHANDLER BLVD
Practice Address - Street 2:BLDG B STE 4
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3697
Practice Address - Country:US
Practice Address - Phone:480-786-4969
Practice Address - Fax:480-786-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225100000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGOtherMEDICARE