Provider Demographics
NPI:1750584108
Name:LEBEC PHYSICAL THERAPY PC DBA LEBEC PHYSICAL THERAPY
Entity type:Organization
Organization Name:LEBEC PHYSICAL THERAPY PC DBA LEBEC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:DESTOUT
Authorized Official - Last Name:LEBEC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-213-1490
Mailing Address - Street 1:55 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-3723
Mailing Address - Country:US
Mailing Address - Phone:928-282-5050
Mailing Address - Fax:
Practice Address - Street 1:55 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-3723
Practice Address - Country:US
Practice Address - Phone:928-282-5050
Practice Address - Fax:928-282-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4052261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
115780Medicare PIN