Provider Demographics
NPI:1386127066
Name:MACIAS, MARIA CAMILA (DPT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CAMILA
Last Name:MACIAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5841
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2490
Mailing Address - Country:US
Mailing Address - Phone:928-722-6050
Mailing Address - Fax:928-722-6094
Practice Address - Street 1:1233 N. MAIN STREET
Practice Address - Street 2:SUITE 10, 11, 12
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85349-0000
Practice Address - Country:US
Practice Address - Phone:928-722-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-30237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist