Provider Demographics
NPI:1538108428
Name:ARIZONA PHYSICAL THERAPY & SPORTS REHABILITATION, P.C.
Entity Type:Organization
Organization Name:ARIZONA PHYSICAL THERAPY & SPORTS REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDROFF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-281-2585
Mailing Address - Street 1:1815 N MASTICK WAY
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1058
Mailing Address - Country:US
Mailing Address - Phone:520-281-2585
Mailing Address - Fax:520-281-2991
Practice Address - Street 1:1815 N MASTICK WAY
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-1046
Practice Address - Country:US
Practice Address - Phone:520-281-2585
Practice Address - Fax:520-281-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27852Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER