Provider Demographics
NPI:1558309286
Name:RADNOTHY, GEORGE LOUIS (PT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:LOUIS
Last Name:RADNOTHY
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 1:9221 E BASELINE RD STE A109-617
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-8379
Mailing Address - Country:US
Mailing Address - Phone:520-885-2263
Mailing Address - Fax:480-357-4639
Practice Address - Street 1:6552 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710
Practice Address - Country:US
Practice Address - Phone:520-885-2263
Practice Address - Fax:520-731-1713
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ531633Medicaid
AZAZ0292080OtherBCBS
188967900OtherACS