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Organization

FOOTHILLS SPORTS MEDICINE & REHABILITATION- TUCSON, LLC

Active
Other names
Proactive Physical Therapy - Marana
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL BASTEN PT (OWNER)
(480) 689-5515
Entity
Organization

Contact information

Practice address
7575 W. TWIN PEAKS RD, SUITE 155, TUCSON, AZ 85743
(520) 744-6445
(520) 742-5252
Mailing address
15410 S MOUNTAIN PKWY STE 112, PHOENIX, AZ 85044-6691
(480) 706-1161
(480) 706-7997

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2251N0400X
Neurology Physical Therapist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AZ0460080
BCBS
AZ
Enumeration date
10/04/2006
Last updated
05/05/2022
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