Provider Demographics
NPI:1063489276
Name:NOVACARE REHABILITATION
Entity Type:Organization
Organization Name:NOVACARE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:559-435-6735
Mailing Address - Street 1:6335 N FRESNO ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5272
Mailing Address - Country:US
Mailing Address - Phone:559-435-6735
Mailing Address - Fax:559-435-5793
Practice Address - Street 1:6335 N FRESNO ST
Practice Address - Street 2:SUITE 108
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5272
Practice Address - Country:US
Practice Address - Phone:559-435-6735
Practice Address - Fax:559-435-5793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty