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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