Provider Demographics
NPI:1457826521
Name:MOONEYHAM PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MOONEYHAM PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BILLER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-298-9120
Mailing Address - Street 1:1823 SHAW AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4064
Mailing Address - Country:US
Mailing Address - Phone:559-298-9120
Mailing Address - Fax:559-298-0822
Practice Address - Street 1:1823 SHAW AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4064
Practice Address - Country:US
Practice Address - Phone:559-298-9120
Practice Address - Fax:559-298-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty