Provider Demographics
NPI:1598853400
Name:SPITZERS PHYSICAL THERAPY AND PERSONAL TRAINING CENTER, INC.
Entity type:Organization
Organization Name:SPITZERS PHYSICAL THERAPY AND PERSONAL TRAINING CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:559-322-5345
Mailing Address - Street 1:615 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1124
Mailing Address - Country:US
Mailing Address - Phone:559-322-5345
Mailing Address - Fax:559-322-5041
Practice Address - Street 1:615 4TH ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1124
Practice Address - Country:US
Practice Address - Phone:559-322-5345
Practice Address - Fax:559-322-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINDIVIDUAL #S225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ08119ZOtherBLUE SHIELD GROUP ID
CA184456400OtherDEPT. OF LABOR
CAZZZ08119ZOtherBLUE SHIELD GROUP ID