Healthcare Provider Details

I. General information

NPI: 1255511036
Provider Name (Legal Business Name): SAMUEL T ANAYA PT DPT OCS MTC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SAM T ANAYA DPT

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6970 N ORACLE RD STE 130
TUCSON AZ
85704-4237
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 520-219-5825
  • Fax: 520-219-5827
Mailing address:
  • Phone: 630-575-1980
  • Fax: 630-928-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2414
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-002414
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: