Provider Demographics
NPI:1447355649
Name:POVAR, DAREN TODD (DPT)
Entity type:Individual
Prefix:DR
First Name:DAREN
Middle Name:TODD
Last Name:POVAR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 E QUEENSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-4091
Mailing Address - Country:US
Mailing Address - Phone:480-951-6598
Mailing Address - Fax:
Practice Address - Street 1:11512 E QUEENSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-4091
Practice Address - Country:US
Practice Address - Phone:480-951-6598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist