1174616734 NPI number — CENTER FOR PHYSICAL MEDICINE & REHABILITATION, P.C.

Table of content: (NPI 1174616734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174616734 NPI number — CENTER FOR PHYSICAL MEDICINE & REHABILITATION, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR PHYSICAL MEDICINE & REHABILITATION, P.C.
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:
1174616734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35009
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85740-5009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-219-0482
Provider Business Mailing Address Fax Number:
520-219-0485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2262 W. MAGEE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-219-0482
Provider Business Practice Location Address Fax Number:
520-219-0485
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JACOBS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
520-219-0482

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  19347 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com