Provider Demographics
NPI:1477550010
Name:DRISCOLL, DENNIS A (PT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:A
Last Name:DRISCOLL
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:PO BOX 36867
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6867
Mailing Address - Country:US
Mailing Address - Phone:520-293-5551
Mailing Address - Fax:520-293-6638
Practice Address - Street 1:5501 N ORACLE RD
Practice Address - Street 2:STE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3850
Practice Address - Country:US
Practice Address - Phone:520-293-5551
Practice Address - Fax:520-293-6638
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86059251885704C002OtherTRICARE
AZ27005Medicare ID - Type UnspecifiedMEDICARE
AZ650012652Medicare ID - Type UnspecifiedRAILROAD MEDICARE