Healthcare Provider Details

I. General information

NPI: 1467429290
Provider Name (Legal Business Name): FORT LOWELL PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 E FORT LOWELL RD
TUCSON AZ
85716-1514
US

IV. Provider business mailing address

2560 E FORT LOWELL RD
TUCSON AZ
85716-1514
US

V. Phone/Fax

Practice location:
  • Phone: 520-323-9086
  • Fax: 520-323-6364
Mailing address:
  • Phone: 520-323-9086
  • Fax: 520-323-6364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1026
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1069
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0554
License Number StateAZ

VIII. Authorized Official

Name: DON SNYDER
Title or Position: OWNER
Credential: P.T.
Phone: 520-323-9086