MEDICARE: CENTER FOR PHYSICAL MEDICINE & REHABILITATION, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	19347	AZ

General Provider Information

NPI Number	:	1174616734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR PHYSICAL MEDICINE & REHABILITATION, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 35009
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85740-5009
Country	:	US
Telephone Number	:	520-219-0482
Fax Number	:	520-219-0485

Provider Business Practice Location Address
First Line	:	2262 W. MAGEE RD.
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742
Country	:	US
Telephone Number	:	520-219-0482
Fax Number	:	520-219-0485

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. DAVID JACOBS
Credential	:	M.D.
Telephone Number	:	520-219-0482

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	02/01/2008

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