Provider Demographics
NPI:1962559120
Name:ESCOBAR, ATILANO JR (PT, MPT)
Entity type:Individual
Prefix:
First Name:ATILANO
Middle Name:
Last Name:ESCOBAR
Suffix:JR
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 N 67TH AVE
Mailing Address - Street 2:100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3605
Mailing Address - Country:US
Mailing Address - Phone:623-979-2747
Mailing Address - Fax:623-979-3122
Practice Address - Street 1:17100 N 67TH AVE
Practice Address - Street 2:100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3605
Practice Address - Country:US
Practice Address - Phone:623-979-2747
Practice Address - Fax:623-979-3122
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ107187Medicare ID - Type Unspecified