Individual
MR. CHARLES DANA BRACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4544 E CAMP LOWELL DR, SUITE 150, TUCSON, AZ 85712-1282
(520) 884-0001
(520) 884-0199
Mailing address
4884 N LOUIS RIVER WAY, TUCSON, AZ 85718-4755
(520) 797-7813
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1026
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00713739
RAILROAD MEDICARE PTAN
AZ
Enumeration date
05/25/2006
Last updated
07/23/2009
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