Provider Demographics
NPI:1487309530
Name:BLUESTONE THERAPY LLC
Entity type:Organization
Organization Name:BLUESTONE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LMT
Authorized Official - Prefix:
Authorized Official - First Name:JAQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:602-405-8182
Mailing Address - Street 1:10769 N FRANK LLOYD WRIGHT BLVD STE A110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2688
Mailing Address - Country:US
Mailing Address - Phone:602-405-8182
Mailing Address - Fax:
Practice Address - Street 1:10769 N FRANK LLOYD WRIGHT BLVD STE A110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2688
Practice Address - Country:US
Practice Address - Phone:602-405-8182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty