Provider Demographics
NPI:1295042356
Name:ROBLES, BRIAN WILLIAM (PTA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:WILLIAM
Last Name:ROBLES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 N ORACLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3829
Mailing Address - Country:US
Mailing Address - Phone:520-747-9225
Mailing Address - Fax:520-747-1633
Practice Address - Street 1:888 S CRAYCROFT RD
Practice Address - Street 2:SUITE 140
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-7118
Practice Address - Country:US
Practice Address - Phone:520-747-5557
Practice Address - Fax:520-747-1633
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8410A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant