| The Physio Shop Llc | |
|
1510 S. Riordan Ranch St., Flagstaff, AZ 86001 | |
| (928) 214-7303 | |
| (928) 214-0696 |
| Full Name | The Physio Shop Llc |
|---|---|
| Type | Facility |
| Speciality | Clinic/center - Physical Therapy |
| Location | 1510 S. Riordan Ranch St., Flagstaff, Arizona |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134524234 | NPI | - | NPPES |
| 126915 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 9032 (Arizona) | Secondary |
| 261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
| Provider Name | Jason C Dorsch |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1023328804 PECOS PAC ID: 6406034362 Enrollment ID: I20110623000132 |
| Provider Name | Jason A Klein |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1952745515 PECOS PAC ID: 9436371630 Enrollment ID: I20141103001532 |
| Provider Name | Benjamin S Wakefield |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1982235792 PECOS PAC ID: 3779910872 Enrollment ID: I20200303000090 |
| Provider Name | John Robert Michael Klass |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1598341091 PECOS PAC ID: 3274942511 Enrollment ID: I20210517002166 |
| Provider Name | Jennifer D Allen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1043323884 PECOS PAC ID: 8527462712 Enrollment ID: I20210810003375 |
| Provider Name | Randall P Cohen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1588608764 PECOS PAC ID: 1254737406 Enrollment ID: I20210914000346 |
| Provider Name | Jackson H Darveaux |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1669125191 PECOS PAC ID: 4082080544 Enrollment ID: I20221025001433 |
| Provider Name | Alexandra Mackay |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1598120396 PECOS PAC ID: 7315249927 Enrollment ID: I20230116000444 |
| Provider Name | Mary L Halbach |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1710001094 PECOS PAC ID: 9335510379 Enrollment ID: I20230130001441 |
| Provider Name | Morgan A Drew |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1619680915 PECOS PAC ID: 9133591696 Enrollment ID: I20230209000484 |
| Provider Name | Corinne Wallis |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1255040358 PECOS PAC ID: 0042682536 Enrollment ID: I20230209001710 |
| Provider Name | Kambrie Stephens |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1073194205 PECOS PAC ID: 1759740277 Enrollment ID: I20230630002270 |
| Provider Name | Heather Harrower |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1205444072 PECOS PAC ID: 7416377833 Enrollment ID: I20231011002530 |
| Provider Name | Brienna C Nixon |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1093123150 PECOS PAC ID: 3870949084 Enrollment ID: I20231024004050 |
| Provider Name | Jennifer Neudorfer |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1962994913 PECOS PAC ID: 3678828050 Enrollment ID: I20240205000604 |
| Provider Name | Patrick Klass |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1396515714 PECOS PAC ID: 7214370105 Enrollment ID: I20240207003577 |
| Provider Name | Larissa Rosano |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1649041906 PECOS PAC ID: 9032556121 Enrollment ID: I20240325003386 |
| Provider Name | Andrew J Castelein |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801586169 PECOS PAC ID: 2860832136 Enrollment ID: I20240503000609 |
| Provider Name | Reuben Cheng |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1750106696 PECOS PAC ID: 3173051729 Enrollment ID: I20250109001740 |
| Mailing Address | Practice Location Address |
|---|---|
| The Physio Shop Llc 1510 S. Riordan Ranch St., Flagstaff, AZ 86001 Ph: (928) 214-7303 | The Physio Shop Llc 1510 S. Riordan Ranch St., Flagstaff, AZ 86001 Ph: (928) 214-7303 |