Basic Information
| Provider Information | |||||||||
| NPI: | 1013393941 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARTZ | ||||||||
| FirstName: | AMBER | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3124 N SWAN RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857121227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203254002 | ||||||||
| FaxNumber: | 5203254227 | ||||||||
| Practice Location | |||||||||
| Address1: | 6264 E GRANT RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857125882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208840001 | ||||||||
| FaxNumber: | 5208840199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2015 | ||||||||
| LastUpdateDate: | 07/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 61032 | OR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 012920 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 270219 | 05 | AZ | MEDICAID | 500690434 | 05 | OR | MEDICAID |