Organization
MDR PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK DOUGLAS ROBERTS P.T. (OWNER MANAGER)
(520) 884-9819
Entity
Organization
Contact information
Practice address
1777 W ST MARYS RD, TUCSON, AZ 85745
(520) 884-9819
(520) 884-0175
Mailing address
1777 W ST MARYS RD, TUCSON, AZ 85745
(520) 884-9819
(520) 884-0175
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4064
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2Z2979
HEALTHNET PROVIDER ID
AZ
01
—
AZ0460510
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
05/03/2007
Last updated
08/22/2020
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