Provider Demographics
NPI:1699592246
Name:TRINITY PHYSICAL THERAPY AND SPORTS MEDICINE
Entity type:Organization
Organization Name:TRINITY PHYSICAL THERAPY AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:623-694-0710
Mailing Address - Street 1:2518 W CORDIA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-3723
Mailing Address - Country:US
Mailing Address - Phone:623-694-0710
Mailing Address - Fax:
Practice Address - Street 1:2518 W CORDIA LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-3723
Practice Address - Country:US
Practice Address - Phone:623-694-0710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty