Desert Edge Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

11446 Issued in AZ

Legal business name

DESERT EDGE PHYSICAL THERAPY LLC

Practice address

10100 W. Lake Pleasant Parkway
Suite 1300
Peoria, AZ 85382

Phone

(623) 334-8767

Fax

(623) 566-5993

NPI assigned

Feb 15, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael King, P.T.NPI 1063675304

Title

Owner/Member

Phone

(623) 235-5772

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Adam King, DPT

  • Physical Therapist
  • Peoria, AZ
  • NPI 1063675304
  Medicare reassignment Care Compare group NPD Authorized official
• Cassidy Cooney, PT

  • Physical Therapist
  • Goodyear, AZ
  • NPI 1457986754
  Medicare reassignment Care Compare group NPD
• Kayli Marie Kullos

  • Physical Therapist
  • Peoria, AZ
  • NPI 1881307627
  Medicare reassignment Care Compare group NPD
• Connor Nickel, DPT

  • Physical Therapist
  • Avondale, AZ
  • NPI 1548837743
  Medicare reassignment Care Compare group NPD
• Spencer Ratkovich, PT, DPT

  • Physical Therapist
  • Peoria, AZ
  • NPI 1053137026
  Medicare reassignment Care Compare group NPD
• Candice Mae Lancaster, DPT

  • Physical Medicine & Rehabilitation Physician
  • Anthem, AZ
  • NPI 1063986362

  Single Specialty

  Medicare reassignment NPD
• Dallis Shingler, PT

  • Physical Therapist
  • Peoria, AZ
  • NPI 1366021206
  Medicare reassignment NPD
• Allison Haines, DPT

  • Physical Therapist
  • Shelby TWP, MI
  • NPI 1881102424

  AZ

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691366400000",
    "number": "1710487707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10100 W. LAKE PLEASANT PARKWAY",
            "address_2": "SUITE 1300",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "85382",
            "telephone_number": "623-334-8767",
            "fax_number": "623-566-5993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 W. LAKE PLEASANT PARKWAY",
            "address_2": "SUITE 1300",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "85382",
            "telephone_number": "623-334-8767",
            "fax_number": "623-566-5993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT EDGE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-15",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "623-235-5772",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AZ",
            "license": "11446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Elizabeth Derminio
• Ann L Derrick, PT
• Jamie R Descoteaux, ARNP
• Desert Amethyst Retirement LLC (Amethyst Gardent)
• Desert Bloom Pediatric Neuropsychology LLC
• Desert Empire Behavioral Health, Inc. (Sonoran Hills Behavioral Health Center)
• Desert Endovascular Surgical Center
• Desert Health Is Wealth PLLC
• Desert Magnolia Therapeutic Services
• Desert Mountain Endodontics

• Physical Therapy Clinic/Center in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Physical Therapy Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.