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Individual

LAURA ELIZABETH TIETJEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MPT OCS

Contact information

Practice address
20325 N 51ST AVE, STE 146, GLENDALE, AZ 85308-5674
(623) 249-3216
(623) 249-3218
Mailing address
12917 W CAMPBELL AVE, LITCHFIELD PARK, AZ 85340-5183
(253) 228-6828

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6773
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00298975
RAILROAD MEDICARE PTAN
AZ
Enumeration date
05/19/2006
Last updated
10/18/2010
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