Provider Demographics
NPI:1821328030
Name:DESERT PALMS PHYSICAL THERAPY- CATALINA PC
Entity Type:Organization
Organization Name:DESERT PALMS PHYSICAL THERAPY- CATALINA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:EGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:520-818-3856
Mailing Address - Street 1:PO BOX 8758
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85738-0758
Mailing Address - Country:US
Mailing Address - Phone:520-385-4066
Mailing Address - Fax:520-818-3857
Practice Address - Street 1:23 MCNAB PARKWAY
Practice Address - Street 2:
Practice Address - City:SAN MANUEL
Practice Address - State:AZ
Practice Address - Zip Code:85631
Practice Address - Country:US
Practice Address - Phone:520-385-4066
Practice Address - Fax:520-385-4132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESERT PALMS PHYSICAL THERAPY CATALINA P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-11
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
AZ6475225100000X
AZ8748225100000X
AZ2987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ283767Medicaid
AZZ119103Medicare PIN
AZ283767Medicaid