Provider Demographics
NPI:1093875460
Name:RANALLA, JOSEPH NICHOLAS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:NICHOLAS
Last Name:RANALLA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11879 KEMPER ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-9021
Mailing Address - Country:US
Mailing Address - Phone:530-885-3940
Mailing Address - Fax:530-885-3984
Practice Address - Street 1:11879 KEMPER ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-9021
Practice Address - Country:US
Practice Address - Phone:530-885-3940
Practice Address - Fax:530-885-3984
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05457ZOtherBLUE SHIELD
CA00PT77350Medicare ID - Type Unspecified
CAZZZ05457ZOtherBLUE SHIELD