Provider Demographics
NPI:1467616953
Name:DIMACALI, FERNANDO G (PT)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:G
Last Name:DIMACALI
Suffix:
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 1:702 N 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-1803
Mailing Address - Country:US
Mailing Address - Phone:509-853-2510
Mailing Address - Fax:509-577-7193
Practice Address - Street 1:702 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-1803
Practice Address - Country:US
Practice Address - Phone:509-853-2510
Practice Address - Fax:509-577-7193
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0236734OtherDEPARTMENT OF LABOR AND INDUSTRIES