Organization Name: | PROFESSIONAL PHYSICAL THERAPY |
NPI Number: | 1578847257 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JULIE S REYNOLDS (P.T. / OWNER) |
Mailing Address: | 2138 Marguerite St Dos Palos |
State: | CA US |
Postal Code: | 936202351 |
Phone Number: | 2093928830 |
Fax Number: | 2093928830 |
NPI Enumeration Date: | 09/29/2011 |
NPI Last Update Date: | 09/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | PT18659 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |