MEDICARE: SANOVA PHYSICAL MEDICINE PLLC

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

General Provider Information

NPI Number	:	1255295994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANOVA PHYSICAL MEDICINE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 89520
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85752-9520
Country	:	US
Telephone Number	:	520-404-5356
Fax Number	:

Provider Business Practice Location Address
First Line	:	15883 N ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85739-9202
Country	:	US
Telephone Number	:	520-404-5356
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIYAN RAD
Credential	:	MD
Telephone Number	:	520-404-5356

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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