MEDICARE: RIDGEVIEW PHYSICAL THERAPY PLLC

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	225100000X	Physical Therapist	9119	AZ

General Provider Information

NPI Number	:	1770982589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDGEVIEW PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	63717 E SADDLEBROOKE BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85739-1258
Country	:	US
Telephone Number	:	520-825-8002
Fax Number	:	520-825-8012

Provider Business Practice Location Address
First Line	:	63717 E SADDLEBROOKE BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85739-1258
Country	:	US
Telephone Number	:	520-825-8002
Fax Number	:	520-825-8012

Authorized Official
Title or Position	:	OWNER/P.T.
Name	:	NOEL J CHAVEZ
Credential	:	P.T., D.P.T., O.C.S.
Telephone Number	:	520-825-8002

Provider Enumeration Date	:	08/18/2014
Last Update Date	:	04/02/2019

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