Provider Demographics
NPI:1598843625
Name:UTTENREITHER, DONALD CHARLES (PT, DSCPT)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CHARLES
Last Name:UTTENREITHER
Suffix:
Gender:M
Credentials:PT, DSCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3318
Mailing Address - Country:US
Mailing Address - Phone:559-782-1501
Mailing Address - Fax:559-782-8528
Practice Address - Street 1:368 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3318
Practice Address - Country:US
Practice Address - Phone:559-782-1501
Practice Address - Fax:559-782-8528
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT9185OtherCALIFORNIA PT LICENSE
CA770371236OtherFEDERAL TAX ID
CA00PT91850Medicare ID - Type UnspecifiedMEDICARE PROVIDER