Healthcare Provider Details

I. General information

NPI: 1790002780
Provider Name (Legal Business Name): CONNIE MAE WEGLARZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 E SHEA BLVD
SCOTTSDALE AZ
85260-6715
US

IV. Provider business mailing address

5910 N LA CHOLLA BLVD
TUCSON AZ
85741-3535
US

V. Phone/Fax

Practice location:
  • Phone: 623-432-8880
  • Fax: 520-498-1400
Mailing address:
  • Phone: 520-498-1800
  • Fax: 520-498-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6897
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: