Provider Demographics
NPI:1164889572
Name:MACASPAC, JOSE H IV (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:H
Last Name:MACASPAC
Suffix:IV
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 1:12155 TRIBUTARY POINT DR APT 124
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4518
Mailing Address - Country:US
Mailing Address - Phone:773-615-0444
Mailing Address - Fax:
Practice Address - Street 1:12155 TRIBUTARY POINT DR APT 124
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670
Practice Address - Country:US
Practice Address - Phone:773-615-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT294981225100000X
IL0700007506282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No282N00000XHospitalsGeneral Acute Care Hospital