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General NPI Number Information
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NPI Number | 1124494737
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Entity Type | Individual
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Provider Name | ETHAN PASTER DPT
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Gender | Male
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Dates
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Enumeration Date | 08/18/2015
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 3601 W CORTARO FARMS RD
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City | TUCSON
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State | AZ
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Zip | 85742-8645
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Country | US
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Telephone | 520-325-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 6521 W SUGAR PINE TRL
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City | TUCSON
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State | AZ
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Zip | 85743-7124
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Country | US
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Telephone | 703-254-3574
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 0013539
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License Number State | CO
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