1245586759 NPI number — TUCSON PHYSICAL THERAPY, PC

Table of content: (NPI 1245586759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245586759 NPI number — TUCSON PHYSICAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUCSON PHYSICAL THERAPY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245586759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15410 S MOUNTAIN PKWY STE 112
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85044-6691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-706-1161
Provider Business Mailing Address Fax Number:
480-706-7997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7601 N ORACLE RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORO VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85704-6310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-293-5551
Provider Business Practice Location Address Fax Number:
520-293-6638
Provider Enumeration Date:
08/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DRISCOLL
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGER/OWNER
Authorized Official Telephone Number:
520-670-9558

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110512 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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