Provider Demographics
NPI:1558628024
Name:TUCSON PHYSCIAL THERAPY, PC
Entity Type:Organization
Organization Name:TUCSON PHYSCIAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-747-9225
Mailing Address - Street 1:5501 N ORACLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3829
Mailing Address - Country:US
Mailing Address - Phone:520-747-9225
Mailing Address - Fax:520-207-1537
Practice Address - Street 1:2945 W INA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2350
Practice Address - Country:US
Practice Address - Phone:520-747-9225
Practice Address - Fax:520-207-1537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0392261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ27004Medicare PIN