Provider Demographics
NPI:1982616165
Name:TANCO, RAYMUND GARCIA (RPT)
Entity type:Individual
Prefix:MR
First Name:RAYMUND
Middle Name:GARCIA
Last Name:TANCO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 DUDLEY BLVD
Mailing Address - Street 2:PHYSICAL THERAPY CLINIC
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-1012
Mailing Address - Country:US
Mailing Address - Phone:916-561-7510
Mailing Address - Fax:
Practice Address - Street 1:5342 DUDLEY BLVD
Practice Address - Street 2:PHYSICAL THERAPY CLINIC
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-1012
Practice Address - Country:US
Practice Address - Phone:916-561-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist