Healthcare Provider Details

I. General information

NPI: 1205921202
Provider Name (Legal Business Name): FOOTHILLS SPORTS MEDICINE & REHABILITATION- TUCSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 W. TWIN PEAKS RD SUITE 155
TUCSON AZ
85743
US

IV. Provider business mailing address

15410 S MOUNTAIN PKWY STE 112
PHOENIX AZ
85044-6691
US

V. Phone/Fax

Practice location:
  • Phone: 520-744-6445
  • Fax: 520-742-5252
Mailing address:
  • Phone: 480-706-1161
  • Fax: 480-706-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BASTEN
Title or Position: OWNER
Credential: PT
Phone: 480-689-5515