Provider Demographics
NPI:1619152519
Name:ORTHOMED LLC
Entity Type:Organization
Organization Name:ORTHOMED LLC
Other - Org Name:PROACTIVE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-545-1127
Mailing Address - Street 1:PO BOX 43085
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3085
Mailing Address - Country:US
Mailing Address - Phone:520-742-7107
Mailing Address - Fax:520-742-9010
Practice Address - Street 1:1925 W ORANGE GROVE RD
Practice Address - Street 2:#204
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1143
Practice Address - Country:US
Practice Address - Phone:520-742-7107
Practice Address - Fax:520-742-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTIN