Provider Demographics
NPI:1790002780
Name:WEGLARZ, CONNIE MAE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:MAE
Last Name:WEGLARZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3535
Mailing Address - Country:US
Mailing Address - Phone:520-498-1800
Mailing Address - Fax:520-498-1400
Practice Address - Street 1:9325 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6715
Practice Address - Country:US
Practice Address - Phone:623-432-8880
Practice Address - Fax:520-498-1400
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist