Provider Demographics
NPI:1275530818
Name:OETTER, JAMES GILBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GILBERT
Last Name:OETTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6970 N ORACLE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4237
Mailing Address - Country:US
Mailing Address - Phone:520-219-5825
Mailing Address - Fax:520-219-5827
Practice Address - Street 1:6970 N ORACLE RD STE 130
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4237
Practice Address - Country:US
Practice Address - Phone:520-219-5825
Practice Address - Fax:520-219-5827
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86059251885704C013OtherTRICARE
AZ68942Medicare ID - Type UnspecifiedMEDICARE
AZ86059251885704C013OtherTRICARE