Provider Demographics
NPI:1427416346
Name:POST-THERAPY RECONDITIONING
Entity Type:Organization
Organization Name:POST-THERAPY RECONDITIONING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-292-1363
Mailing Address - Street 1:2410 W RUTHRAUFF RD STE 110P
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1952
Mailing Address - Country:US
Mailing Address - Phone:520-293-7736
Mailing Address - Fax:520-292-1362
Practice Address - Street 1:2410 W RUTHRAUFF RD STE 110P
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1952
Practice Address - Country:US
Practice Address - Phone:520-293-7736
Practice Address - Fax:520-292-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X
AZAP5496363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ563892Medicaid
AZ6728150001Medicare NSC