Provider Demographics
NPI:1902005333
Name:SPITZER'S PHYSICAL THERAPY AND PERSONAL TRAINING CENTER, INC.
Entity Type:Organization
Organization Name:SPITZER'S PHYSICAL THERAPY AND PERSONAL TRAINING CENTER, INC.
Other - Org Name:SPITZER'S PHYSICAL THERAPY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:559-322-5345
Mailing Address - Street 1:615 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1124
Mailing Address - Country:US
Mailing Address - Phone:559-322-5345
Mailing Address - Fax:559-322-5041
Practice Address - Street 1:524 S CLOVIS AVE STE I
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4529
Practice Address - Country:US
Practice Address - Phone:559-322-5345
Practice Address - Fax:559-322-5041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPITZER'S PHYSICAL THERAPY AND PERSONAL TRAINING CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-16
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ08120ZOtherBLUE SHIELD
CA184456400OtherDEPARTMENT OF LABOR
CAZZZ27924ZMedicare PIN