Provider Demographics
NPI:1073509808
Name:SONORAN SHOULDER ELBOW HAND REHAB PC
Entity Type:Organization
Organization Name:SONORAN SHOULDER ELBOW HAND REHAB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:VONKERSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:PT CHT
Authorized Official - Phone:520-747-2959
Mailing Address - Street 1:899 N. WILMOT ROAD
Mailing Address - Street 2:SUITE D3
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1713
Mailing Address - Country:US
Mailing Address - Phone:520-747-2959
Mailing Address - Fax:520-747-2918
Practice Address - Street 1:899 N. WILMOT ROAD
Practice Address - Street 2:SUITE D3
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1713
Practice Address - Country:US
Practice Address - Phone:520-747-2959
Practice Address - Fax:520-747-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20842251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0461690OtherBCBSAZ
AZAZ0461690OtherBCBSAZ
AZ4912640001Medicare NSC