Provider Demographics
NPI:1639382401
Name:RADOMSKI, MAUREEN BRENNAN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:BRENNAN
Last Name:RADOMSKI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:ELIZABETH
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:8311 E VIA DE VENTURA
Mailing Address - Street 2:APT #1130
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-6600
Mailing Address - Country:US
Mailing Address - Phone:480-326-8779
Mailing Address - Fax:
Practice Address - Street 1:8311 E VIA DE VENTURA
Practice Address - Street 2:APT #1130
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-6600
Practice Address - Country:US
Practice Address - Phone:480-326-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ691908OtherAHHCCS
AZAZ0463140OtherBCBS OF AZ