Provider Demographics
NPI:1790987451
Name:CENTRAL CALIFORNIA PHYSICAL THERAPY SPECIALIST
Entity Type:Organization
Organization Name:CENTRAL CALIFORNIA PHYSICAL THERAPY SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONNA
Authorized Official - Middle Name:KNOX
Authorized Official - Last Name:SCHENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MAPT
Authorized Official - Phone:559-625-2476
Mailing Address - Street 1:3362 S FAIRWAY ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8109
Mailing Address - Country:US
Mailing Address - Phone:559-625-2476
Mailing Address - Fax:
Practice Address - Street 1:3362 S FAIRWAY ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8109
Practice Address - Country:US
Practice Address - Phone:559-625-2476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT114181Medicare ID - Type UnspecifiedMEDICARE