Organization
ORTHOMED LLC
Active
Other names
PROACTIVE PHYSICAL THERPY
Organization subpart
No
Provider details
NPI number
Authorized official
SERENA LEWIS (ADMINISTRATOR)
(520) 829-7712
Entity
Organization
Contact information
Practice address
3945 E PARADISE FALLS DR, STE 109, TUCSON, AZ 85712-6683
(520) 321-0204
(520) 321-0495
Mailing address
PO BOX 64207, TUCSON, AZ 85728-4207
(520) 829-7712
(520) 314-4121
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
825036
—
AZ
Enumeration date
06/09/2008
Last updated
12/16/2014
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