Provider Demographics
NPI:1689129520
Name:HOMAN, GEORGE BRUCE JR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BRUCE
Last Name:HOMAN
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 COFFEE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3164
Mailing Address - Country:US
Mailing Address - Phone:209-576-0888
Mailing Address - Fax:
Practice Address - Street 1:950 OAKDALE RD STE F
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4594
Practice Address - Country:US
Practice Address - Phone:209-622-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-21
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212381225100000X
ALPTH9238225100000X
NJ40QA01584000225100000X
CAPT298540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist