Provider Demographics
NPI:1154490563
Name:BOLICH, JAMES J (LPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:BOLICH
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 W CROMWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6782
Mailing Address - Country:US
Mailing Address - Phone:559-269-6160
Mailing Address - Fax:559-438-4339
Practice Address - Street 1:484 W CROMWELL AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6782
Practice Address - Country:US
Practice Address - Phone:559-269-6160
Practice Address - Fax:559-438-4339
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT14135OtherPHYSICAL THERAPY LICENSE