| Organization Name: | PHYSICAL THERAPY CLINIC OF GOLD CANYON |
| NPI Number: | 1407049331 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DARLENE MARIE CHURCHMAN (OFFICE MANAGER) |
| Mailing Address: | 6410 S Kings Ranch Rd Suite 2 Gold Canyon |
| State: | AZ US |
| Postal Code: | 851187352 |
| Phone Number: | 4809832259 |
| Fax Number: | 4809832259 |
| NPI Enumeration Date: | 08/23/2007 |
| NPI Last Update Date: | 10/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 378 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |