Healthcare Provider Details

I. General information

NPI: 1114306917
Provider Name (Legal Business Name): TUCSON CONCUSSION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5199 E FARNESS DR SUITE 101
TUCSON AZ
85712-2134
US

IV. Provider business mailing address

5199 EAST FARNESS SUITE 101
TUCSON AZ
85712-2134
US

V. Phone/Fax

Practice location:
  • Phone: 844-822-6824
  • Fax:
Mailing address:
  • Phone: 520-620-9100
  • Fax: 844-822-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HIRSCH HANDMAKER
Title or Position: CHAIRMAN/CEO
Credential: M.D.
Phone: 310-259-2090