Provider Demographics
NPI:1952493520
Name:DIRENFELD PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:DIRENFELD PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:DIRENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-297-8842
Mailing Address - Street 1:2163 W ORANGE GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3118
Mailing Address - Country:US
Mailing Address - Phone:520-297-8842
Mailing Address - Fax:520-297-6986
Practice Address - Street 1:2163 W ORANGE GROVE ROAD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3118
Practice Address - Country:US
Practice Address - Phone:520-297-8842
Practice Address - Fax:520-297-6986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1135225100000X
AZ5543225100000X
AZ5765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0250730OtherBLUE CROSS BLUE SHIELD
AZAZ0250730OtherBLUE CROSS BLUE SHIELD