Basic Information
| Provider Information | |||||||||
| NPI: | 1124494737 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PASTER | ||||||||
| FirstName: | ETHAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2552 E HALCYON RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857161114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032543574 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3124 N SWAN RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857121227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203254002 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2015 | ||||||||
| LastUpdateDate: | 08/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251S0007X | 0013539 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No ID Information.