Provider Demographics
NPI:1639821754
Name:URBAN, ANTHONY DAVID (DPT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DAVID
Last Name:URBAN
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 1:1777 W ORANGE GROVE RD APT 3201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W3216 COUNTRY ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-9432
Practice Address - Country:US
Practice Address - Phone:920-460-9390
Practice Address - Fax:920-404-2021
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31795225100000X
WI16645-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist