Provider Demographics
NPI:1699728188
Name:PHYS MED A PHYSICAL THERAPY CORPORATION
Entity type:Organization
Organization Name:PHYS MED A PHYSICAL THERAPY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLASENKO
Authorized Official - Middle Name:HUGO
Authorized Official - Last Name:SIMUNOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:559-438-4300
Mailing Address - Street 1:7033 N FRESNO ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2976
Mailing Address - Country:US
Mailing Address - Phone:559-438-4300
Mailing Address - Fax:559-438-4339
Practice Address - Street 1:7033 N FRESNO ST STE 202
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2976
Practice Address - Country:US
Practice Address - Phone:559-438-4300
Practice Address - Fax:559-438-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056629Medicare UPIN