Provider Demographics
NPI:1144618547
Name:PATINDOL, EDGAR VELASCO JR (PT)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:VELASCO
Last Name:PATINDOL
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LINDA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-1129
Mailing Address - Country:US
Mailing Address - Phone:408-912-6265
Mailing Address - Fax:
Practice Address - Street 1:4840 E TULARE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3062
Practice Address - Country:US
Practice Address - Phone:559-251-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist