Provider Demographics
NPI:1952511610
Name:VALENZUELA, ALFRED JOSEPH (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:JOSEPH
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:FRED
Other - Middle Name:JOSEPH
Other - Last Name:VALENZUELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPY
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-0532
Mailing Address - Country:US
Mailing Address - Phone:520-432-4224
Mailing Address - Fax:
Practice Address - Street 1:1031 AVENIDA PICO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673
Practice Address - Country:US
Practice Address - Phone:949-366-3362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 3454225100000X
AZ5002225100000X
UT5896880-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist