MEDICARE: TUCSON PHYSICAL THERAPY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0290250	OTHER	AZ	BCBS OF AZ

General Provider Information

NPI Number	:	1407851322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUCSON PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	5501 N ORACLE RD
Second Line	:	STE 101
City	:	TUCSON
State	:	AZ
Zip	:	85704-3850
Country	:	US
Telephone Number	:	520-293-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 N ORACLE RD
Second Line	:	STE 101
City	:	TUCSON
State	:	AZ
Zip	:	85704-3850
Country	:	US
Telephone Number	:	520-293-5551
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DENNIS A DRISCOLL
Credential	:	PT
Telephone Number	:	520-293-5551

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	04/08/2008

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