Provider Demographics
NPI:1821562489
Name:PBMA LLC
Entity Type:Organization
Organization Name:PBMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEESCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:559-896-6565
Mailing Address - Street 1:2725 7TH AVENUE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-2512
Mailing Address - Country:US
Mailing Address - Phone:559-896-6565
Mailing Address - Fax:559-896-5740
Practice Address - Street 1:2251 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3859
Practice Address - Country:US
Practice Address - Phone:559-896-6565
Practice Address - Fax:559-896-5740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy