Provider Demographics
NPI:1710208897
Name:RIZO, JOSE C JR (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:C
Last Name:RIZO
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:C
Other - Last Name:RIZO
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3733 SAN DIMAS ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1407
Mailing Address - Country:US
Mailing Address - Phone:661-635-3403
Mailing Address - Fax:
Practice Address - Street 1:3733 SAN DIMAS
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2306
Practice Address - Country:US
Practice Address - Phone:661-635-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21296ZOtherMEDICARE GROUP PTAN