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NPI Code Detail

MEDICARE: ROBERT B DIRENFELD DPT

MEDICARE: ROBERT B DIRENFELD DPT
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
1225100000XPhysical Therapist1135AZ
2225100000XPhysical TherapistLPT-001135AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962404293
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT B DIRENFELD DPT
Provider Business Mailing Address
First Line : 2122 YORK RD STE 300
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-1925
Country : US
Telephone Number : 630-575-6200
Fax Number : 630-575-7450
Provider Business Practice Location Address
First Line : 13395 N MARANA MAIN ST
Second Line :
City : MARANA
State : AZ
Zip : 85653-7008
Country : US
Telephone Number : 520-682-9645
Fax Number : 520-682-9646
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 02/04/2021

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Directions to “ ROBERT B DIRENFELD DPT” Practice Location

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