Provider Demographics
NPI:1881644961
Name:PIRTLE, MARK FARRIS (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:FARRIS
Last Name:PIRTLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 E DRACHMAN ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3507
Mailing Address - Country:US
Mailing Address - Phone:520-795-3563
Mailing Address - Fax:
Practice Address - Street 1:2506 E DRACHMAN ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3507
Practice Address - Country:US
Practice Address - Phone:520-795-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106993Medicare ID - Type UnspecifiedMEDICARE NUMBER