Provider Demographics
NPI:1245468966
Name:RINCON REHAB, FITNESS, & WELLNESS, PC
Entity type:Organization
Organization Name:RINCON REHAB, FITNESS, & WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-403-5122
Mailing Address - Street 1:10920 S RAPTOR CT
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-6418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10920 S RAPTOR CT
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-6418
Practice Address - Country:US
Practice Address - Phone:520-403-5122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5363261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy