MEDICARE: MDR PHYSICAL THERAPY INC.

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		AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972869626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDR PHYSICAL THERAPY INC.

Provider Business Mailing Address
First Line	:	8987 E TANQUE VERDE RD
Second Line	:	STE. 301
City	:	TUCSON
State	:	AZ
Zip	:	85749-9610
Country	:	US
Telephone Number	:	520-884-4292
Fax Number	:

Provider Business Practice Location Address
First Line	:	8987 E TANQUE VERDE RD
Second Line	:	STE. 301
City	:	TUCSON
State	:	AZ
Zip	:	85749-9610
Country	:	US
Telephone Number	:	520-884-4292
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. MARK D ROBERTS
Credential	:	P.T.
Telephone Number	:	520-884-9819

Provider Enumeration Date	:	04/06/2012
Last Update Date	:	04/06/2012

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