Provider Demographics
NPI:1013089291
Name:FUNCTIONAL INDUSTRIAL REHABILITATION MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:FUNCTIONAL INDUSTRIAL REHABILITATION MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIMISHA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GREATHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-224-6754
Mailing Address - Street 1:6042 N FRESNO ST
Mailing Address - Street 2:101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5279
Mailing Address - Country:US
Mailing Address - Phone:559-224-6754
Mailing Address - Fax:559-490-0105
Practice Address - Street 1:6042 N FRESNO ST
Practice Address - Street 2:101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5279
Practice Address - Country:US
Practice Address - Phone:559-224-6754
Practice Address - Fax:559-490-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty