Provider Demographics
NPI:1184677486
Name:OROFINO, CHARLES LOUIS (PT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:LOUIS
Last Name:OROFINO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:
Other - Last Name:OROFINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3106 PONTE MORINO DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8277
Mailing Address - Country:US
Mailing Address - Phone:530-677-7565
Mailing Address - Fax:530-677-7683
Practice Address - Street 1:3106 PONTE MORINO DR
Practice Address - Street 2:SUITE A
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8277
Practice Address - Country:US
Practice Address - Phone:530-677-7565
Practice Address - Fax:530-677-7683
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist