Provider Demographics
NPI:1316106792
Name:PFOTENHAUER, GARY WARREN (PT)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:WARREN
Last Name:PFOTENHAUER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6651 E CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2118
Mailing Address - Country:US
Mailing Address - Phone:520-731-8533
Mailing Address - Fax:520-721-3601
Practice Address - Street 1:6651 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2118
Practice Address - Country:US
Practice Address - Phone:520-731-8533
Practice Address - Fax:520-721-3601
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist