Provider Demographics
NPI:1962545814
Name:CENTER FOR ATHLETIC PERFORMANCE & PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:CENTER FOR ATHLETIC PERFORMANCE & PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-380-6807
Mailing Address - Street 1:5325 E PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3627
Mailing Address - Country:US
Mailing Address - Phone:602-380-6807
Mailing Address - Fax:
Practice Address - Street 1:5325 E PERSHING AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3627
Practice Address - Country:US
Practice Address - Phone:602-380-6807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0911867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ080077Medicaid
AZ6696940001OtherMEDICARE DME