Provider Demographics
NPI:1497963664
Name:DASH THERAPY A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DASH THERAPY A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:CHT
Authorized Official - Phone:559-627-3274
Mailing Address - Street 1:1827 S COURT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-5469
Mailing Address - Country:US
Mailing Address - Phone:559-627-3274
Mailing Address - Fax:559-627-3284
Practice Address - Street 1:1827 S. COURT ST
Practice Address - Street 2:SUITE C
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-5469
Practice Address - Country:US
Practice Address - Phone:559-627-3274
Practice Address - Fax:559-627-3284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABL021941261QP2000X
CA1497963664332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6588330001Medicare NSC
CA1497963664Medicare NSC