Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 6134 | AZ |
N | 2251G0304X | Physical Therapist - Geriatrics | 6134 | AZ |
N | 2251S0007X | Physical Therapist - Sports | 6134 | AZ |
N | 2251X0800X | Physical Therapist - Orthopedic | 6134 | AZ |
NPI | 1023008273 |
---|---|
Provider Name | Dr. Jennifer A Zoucha |
First Address | Tucson, AZ 85751-1630 |
Second Address | Tucson, AZ 85712-6115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 03/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
791097 | (05) | AZ |
AZ0460450 | BCBS (01) |