Provider Demographics
NPI:1861444119
Name:CREATIVE THERAPEUTICS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:CREATIVE THERAPEUTICS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATINKA
Authorized Official - Middle Name:E
Authorized Official - Last Name:YEPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-294-8112
Mailing Address - Street 1:2763 E SHAW AVE
Mailing Address - Street 2:#102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8220
Mailing Address - Country:US
Mailing Address - Phone:559-294-8112
Mailing Address - Fax:559-294-7805
Practice Address - Street 1:2763 E SHAW AVE
Practice Address - Street 2:#102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8220
Practice Address - Country:US
Practice Address - Phone:559-294-8112
Practice Address - Fax:559-294-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty