1912038456 NPI number — C O R E PHYSICAL THERAPY OF VISALIA INC

Table of content: (NPI 1912038456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912038456 NPI number — C O R E PHYSICAL THERAPY OF VISALIA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C O R E PHYSICAL THERAPY OF VISALIA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMPREHENSIVE ORTHOPEDIC REHABILITATION & EDUCATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912038456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2805 W ELOWIN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93291-2688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-636-7994
Provider Business Mailing Address Fax Number:
559-636-7996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1138 N CHINOWTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-679-2797
Provider Business Practice Location Address Fax Number:
559-713-1234
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YORK
Authorized Official First Name:
LETICIA
Authorized Official Middle Name:
PANTOJA
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
559-967-1320

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  9406 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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