Provider Demographics
NPI:1811108541
Name:PARADISE VALLEY PHYSICAL THERAPY, PLC
Entity type:Organization
Organization Name:PARADISE VALLEY PHYSICAL THERAPY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:W
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-424-0494
Mailing Address - Street 1:4550 E BELL RD
Mailing Address - Street 2:BLDG 8 STE 270
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2158
Mailing Address - Country:US
Mailing Address - Phone:602-424-0494
Mailing Address - Fax:602-424-0493
Practice Address - Street 1:4550 E BELL RD
Practice Address - Street 2:BLDG 8 STE 270
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2159
Practice Address - Country:US
Practice Address - Phone:602-424-0494
Practice Address - Fax:602-424-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty