Provider Demographics
NPI:1912144015
Name:SHIFREN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SHIFREN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:RAOUL
Authorized Official - Last Name:SHIFREN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-572-6540
Mailing Address - Street 1:16256 N ORACLE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-4294
Mailing Address - Country:US
Mailing Address - Phone:520-572-6540
Mailing Address - Fax:520-818-3868
Practice Address - Street 1:16256 N ORACLE RD
Practice Address - Street 2:SUITE120
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-4382
Practice Address - Country:US
Practice Address - Phone:520-572-6540
Practice Address - Fax:520-572-6540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-11
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty