Provider Demographics
NPI:1578971198
Name:MDR PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MDR PHYSICAL THERAPY, INC
Other - Org Name:AGILITY SPINE AND SPORTS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-884-9819
Mailing Address - Street 1:1777 W ST. MARY'S ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745
Mailing Address - Country:US
Mailing Address - Phone:520-884-9819
Mailing Address - Fax:520-884-0175
Practice Address - Street 1:1605 E RIVER ROAD, SUITE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-884-9819
Practice Address - Fax:520-884-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty