Healthcare Provider Details

I. General information

NPI: 1902047418
Provider Name (Legal Business Name): MARIPOSA THERAPIES OF TUCSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N TUCSON BLVD STE 5 A
TUCSON AZ
85716-3425
US

IV. Provider business mailing address

1601 N TUCSON BLVD STE 5 A
TUCSON AZ
85716-3425
US

V. Phone/Fax

Practice location:
  • Phone: 520-325-3540
  • Fax: 520-325-8259
Mailing address:
  • Phone: 520-325-3540
  • Fax: 520-325-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number0416
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1879
License Number StateAZ

VIII. Authorized Official

Name: MARY C O'CONNELL
Title or Position: PARTNER/THERAPIST
Credential: MC PT
Phone: 520-325-3540