Provider Demographics
NPI:1912038456
Name:C O R E PHYSICAL THERAPY OF VISALIA INC
Entity Type:Organization
Organization Name:C O R E PHYSICAL THERAPY OF VISALIA INC
Other - Org Name:COMPREHENSIVE ORTHOPEDIC REHABILITATION & EDUCATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:PANTOJA
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC,SLP
Authorized Official - Phone:559-967-1320
Mailing Address - Street 1:2805 W ELOWIN CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-2688
Mailing Address - Country:US
Mailing Address - Phone:559-636-7994
Mailing Address - Fax:559-636-7996
Practice Address - Street 1:1138 N CHINOWTH ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-679-2797
Practice Address - Fax:559-713-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty