Picacho 1, LLC

NPI #1528536554 in Queen Creek, Arizona

Provider Information

NPI Number: 1528536554
Entity Type: Organization
Organization Name: Picacho 1, LLC
Primary Specialty: Physical Therapist
Enumeration Date: Nov 7, 2018
Last Updated: Nov 7, 2018

Practice Location

Address: 20715 E OCOTILLO RD
Address 2: SUITE 103
City: Queen Creek
State: Arizona
ZIP Code: 85142
Phone: (480) 495-6574

Authorized Official

Name: STANLEY FLOYD CARR
Title: OWNER
Phone: (480) 495-6574

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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