Provider Demographics
NPI:1508449141
Name:TOVAR, MARK ANTHONY JR (PTA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:TOVAR
Suffix:JR
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 1:8138 W TONTO LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2809
Mailing Address - Country:US
Mailing Address - Phone:602-320-3312
Mailing Address - Fax:
Practice Address - Street 1:9376 E BAHIA DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1532
Practice Address - Country:US
Practice Address - Phone:480-556-8406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14290225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant