Provider Demographics
NPI:1194964536
Name:DON UTTENREITHER PHYSICAL THERAPY
Entity type:Organization
Organization Name:DON UTTENREITHER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:FANCHON
Authorized Official - Last Name:QUIRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-782-1501
Mailing Address - Street 1:368 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3318
Mailing Address - Country:US
Mailing Address - Phone:559-782-1501
Mailing Address - Fax:559-782-8528
Practice Address - Street 1:368 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3318
Practice Address - Country:US
Practice Address - Phone:559-782-1501
Practice Address - Fax:559-782-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT91850261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT9185OtherCALIFORNIA PT LICENSE
CAPT9185OtherCALIFORNIA PT LICENSE