Provider Demographics
NPI:1376575837
Name:RASCAL CREEK PHYSICAL THERAPY A PROFESSIONAL CORPORATION.
Entity Type:Organization
Organization Name:RASCAL CREEK PHYSICAL THERAPY A PROFESSIONAL CORPORATION.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:209-722-1030
Mailing Address - Street 1:3327 M ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2714
Mailing Address - Country:US
Mailing Address - Phone:209-722-1030
Mailing Address - Fax:209-722-5408
Practice Address - Street 1:3327 M ST
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2705
Practice Address - Country:US
Practice Address - Phone:209-722-1030
Practice Address - Fax:209-722-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15785ZMedicare ID - Type Unspecified