Provider Demographics
NPI:1629149398
Name:DRYSDALE, GEORGE A (DPT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:DRYSDALE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7275 N 1ST ST STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2977
Mailing Address - Country:US
Mailing Address - Phone:559-431-6777
Mailing Address - Fax:559-431-6777
Practice Address - Street 1:7275 N 1ST ST STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2977
Practice Address - Country:US
Practice Address - Phone:559-431-6700
Practice Address - Fax:559-431-6777
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24827225100000X
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT248270Medicare ID - Type Unspecified