Provider Demographics
NPI:1710484506
Name:ONOFRIO, EDWARD REGINALD (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:REGINALD
Last Name:ONOFRIO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18938
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85731-8938
Mailing Address - Country:US
Mailing Address - Phone:520-808-1930
Mailing Address - Fax:
Practice Address - Street 1:300 S OCOTILLO AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6401
Practice Address - Country:US
Practice Address - Phone:520-586-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic