Healthcare Provider Details

I. General information

NPI: 1124950316
Provider Name (Legal Business Name): EZRA DAVID
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N WILMOT RD
TUCSON AZ
85711-2601
US

IV. Provider business mailing address

321 N FREMONT AVE APT 206
TUCSON AZ
85719-5462
US

V. Phone/Fax

Practice location:
  • Phone: 520-540-2001
  • Fax:
Mailing address:
  • Phone: 413-923-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034798
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: