Healthcare Provider Details

I. General information

NPI: 1184628562
Provider Name (Legal Business Name): POLARIS PHYSICAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 E RIVER ROAD
TUCSON AZ
85718
US

IV. Provider business mailing address

2404 E RIVER ROAD
TUCSON AZ
85718
US

V. Phone/Fax

Practice location:
  • Phone: 520-408-9868
  • Fax: 520-300-7020
Mailing address:
  • Phone: 520-408-9868
  • Fax: 520-300-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3974
License Number StateAZ

VIII. Authorized Official

Name: MATTHEW LINCOLN SPARROW
Title or Position: OWNER
Credential: M.P.T.
Phone: 520-408-9868