Provider Demographics
NPI:1538157193
Name:CHURCHMAN, MICHAEL HARVEY (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HARVEY
Last Name:CHURCHMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 S KINGS RANCH RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-7352
Mailing Address - Country:US
Mailing Address - Phone:480-983-2259
Mailing Address - Fax:480-983-2259
Practice Address - Street 1:6410 S KINGS RANCH RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-7352
Practice Address - Country:US
Practice Address - Phone:480-983-2259
Practice Address - Fax:480-983-2259
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z1387OtherHEALTHNET
AZ670001707OtherRR MEDICARE
AZ014283101Medicaid
AZ7092239OtherAETNA
860681342OtherCOMMERCIAL
AZ1Z1387OtherHEALTHNET