Provider Demographics
NPI:1255426318
Name:CAMELBACK SPORTS THERAPY LLC
Entity type:Organization
Organization Name:CAMELBACK SPORTS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SEMON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:602-808-8989
Mailing Address - Street 1:PO BOX 44767
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-4767
Mailing Address - Country:US
Mailing Address - Phone:602-808-8989
Mailing Address - Fax:602-808-9494
Practice Address - Street 1:4800 N 44TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3800
Practice Address - Country:US
Practice Address - Phone:602-808-8989
Practice Address - Fax:602-808-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ71431Medicare PIN