1912144015 NPI number — SHIFREN PHYSICAL THERAPY

Table of content: (NPI 1912144015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912144015 NPI number — SHIFREN PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIFREN PHYSICAL THERAPY
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:
1912144015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16256 N ORACLE RD STE 120
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:
85739-4294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-572-6540
Provider Business Mailing Address Fax Number:
520-818-3868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16256 N ORACLE RD
Provider Second Line Business Practice Location Address:
SUITE120
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85739-4382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-572-6540
Provider Business Practice Location Address Fax Number:
520-572-6540
Provider Enumeration Date:
01/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SHIFREN
Authorized Official First Name:
NOLAN
Authorized Official Middle Name:
RAOUL
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
520-572-6540

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5624 , 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