Provider Demographics
NPI:1922086883
Name:MARANA PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MARANA PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCOLLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-308-4878
Mailing Address - Street 1:9190 N COACHLINE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7359
Mailing Address - Country:US
Mailing Address - Phone:520-308-4878
Mailing Address - Fax:520-308-4874
Practice Address - Street 1:9190 N COACHLINE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7359
Practice Address - Country:US
Practice Address - Phone:520-308-4878
Practice Address - Fax:520-308-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-02
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0460840OtherBCBS PROVIDER #
AZ200668200OtherACS PROVIDER #
AZ========= 001OtherTRICARE PROVIDER #