Provider Demographics
NPI:1497950414
Name:GEORGE L RADNOTHY PT
Entity Type:Organization
Organization Name:GEORGE L RADNOTHY PT
Other - Org Name:ACADEMY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RADNOTHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-885-2263
Mailing Address - Street 1:6510 E CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2168
Mailing Address - Country:US
Mailing Address - Phone:520-885-2263
Mailing Address - Fax:520-731-1713
Practice Address - Street 1:6510 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2168
Practice Address - Country:US
Practice Address - Phone:520-885-2263
Practice Address - Fax:520-731-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRPT1245AMedicare PIN