Provider Demographics
NPI:1073094579
Name:CORE PHYSICAL THERAPY BY BRYAN PACILLAS PC
Entity Type:Organization
Organization Name:CORE PHYSICAL THERAPY BY BRYAN PACILLAS PC
Other - Org Name:CORE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PACILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-671-0101
Mailing Address - Street 1:2643 N CHINOWTH ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8077
Mailing Address - Country:US
Mailing Address - Phone:559-679-2797
Mailing Address - Fax:
Practice Address - Street 1:1136 N CHINOWTH ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4113
Practice Address - Country:US
Practice Address - Phone:559-671-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty