Provider Demographics
NPI:1174292064
Name:RICH, ANTHONY RAYMOND JR (DPT, FAAOMPT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RAYMOND
Last Name:RICH
Suffix:JR
Gender:M
Credentials:DPT, FAAOMPT
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:RAYMOND
Other - Last Name:RICH
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:2520 E WILCOX DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2843
Mailing Address - Country:US
Mailing Address - Phone:520-685-8522
Mailing Address - Fax:520-336-9485
Practice Address - Street 1:2520 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2843
Practice Address - Country:US
Practice Address - Phone:815-326-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.026013225100000X
AZ20592204D00000X, 172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPT-32036OtherAZ STATE LICENSE
IL070.026013OtherILLINOIS LICENSE NUMBER