Provider Demographics
NPI:1225501281
Name:ENGAGE PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:ENGAGE PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LUCE
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,OCS,SCS
Authorized Official - Phone:661-200-9660
Mailing Address - Street 1:1160 E LERDO HWY UNIT B
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-9417
Mailing Address - Country:US
Mailing Address - Phone:661-200-9660
Mailing Address - Fax:
Practice Address - Street 1:1160 E LERDO HWY UNIT B
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-9417
Practice Address - Country:US
Practice Address - Phone:661-200-9660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29807OtherPT LICENSE NUMBER