Provider Demographics
NPI:1710404389
Name:CANYON PHYSICAL THERAPY GLENDALE LLC
Entity type:Organization
Organization Name:CANYON PHYSICAL THERAPY GLENDALE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-374-2910
Mailing Address - Street 1:19420 N 59TH AVE STE H830
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6980
Mailing Address - Country:US
Mailing Address - Phone:623-374-2910
Mailing Address - Fax:
Practice Address - Street 1:19420 N 59TH AVE STE H830
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6980
Practice Address - Country:US
Practice Address - Phone:623-374-2910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANYON PHYSICAL THERAPY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty