Provider Demographics
NPI:1639493968
Name:SANTA CRUZ PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:SANTA CRUZ PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-281-2585
Mailing Address - Street 1:1815 N MASTICK WAY
Mailing Address - Street 2:#2
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1046
Mailing Address - Country:US
Mailing Address - Phone:520-281-2585
Mailing Address - Fax:520-281-2991
Practice Address - Street 1:1815 N MASTICK WAY
Practice Address - Street 2:#2
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-1046
Practice Address - Country:US
Practice Address - Phone:520-281-2585
Practice Address - Fax:520-281-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ11343629OtherCAQH