Provider Demographics
NPI:1679852289
Name:BRANSON PHYSICAL THERAPY A ARIZONA LLC
Entity type:Organization
Organization Name:BRANSON PHYSICAL THERAPY A ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:480-983-1680
Mailing Address - Street 1:850 S IRONWOOD DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-6242
Mailing Address - Country:US
Mailing Address - Phone:480-983-1680
Mailing Address - Fax:480-983-1681
Practice Address - Street 1:850 S IRONWOOD DR
Practice Address - Street 2:SUITE 112
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-6242
Practice Address - Country:US
Practice Address - Phone:480-983-1680
Practice Address - Fax:480-983-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3316261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ859613OtherOPTUM
AZ16798522859OtherBCBS
S83866Medicare UPIN
AZ16798522859OtherBCBS