Provider Demographics
NPI:1841583689
Name:ESCAMILLA, RAFAEL FIDEL (PT, PHD)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:FIDEL
Last Name:ESCAMILLA
Suffix:
Gender:M
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 J STREET
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-6020
Mailing Address - Country:US
Mailing Address - Phone:850-736-3060
Mailing Address - Fax:
Practice Address - Street 1:2217 SUNSET BLVD
Practice Address - Street 2:SUITE 711
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4781
Practice Address - Country:US
Practice Address - Phone:850-736-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist