Healthcare Provider Details

I. General information

NPI: 1992741425
Provider Name (Legal Business Name): INTEGRATED PAIN CENTER OF ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 E. PARADISE FALLS DR. #105
TUCSON AZ
85712-6683
US

IV. Provider business mailing address

3945 E. PARADISE FALLS DR. # 105
TUCSON AZ
85712-6683
US

V. Phone/Fax

Practice location:
  • Phone: 520-797-7246
  • Fax: 520-795-4249
Mailing address:
  • Phone: 520-797-7246
  • Fax: 520-795-4249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTIE RENEE ALTHERR
Title or Position: PRACTICE MANAGER
Credential:
Phone: 520-322-6274