Healthcare Provider Details

I. General information

NPI: 1962559120
Provider Name (Legal Business Name): ATILANO ESCOBAR JR. PT, MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 N 67TH AVE 100
GLENDALE AZ
85308-3605
US

IV. Provider business mailing address

17100 N 67TH AVE 100
GLENDALE AZ
85308-3605
US

V. Phone/Fax

Practice location:
  • Phone: 623-979-2747
  • Fax: 623-979-3122
Mailing address:
  • Phone: 623-979-2747
  • Fax: 623-979-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3275
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: