Provider Demographics
NPI:1023103199
Name:VALDEZ, ANTONIO (OT)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 N CARSON ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291
Mailing Address - Country:US
Mailing Address - Phone:559-739-8429
Mailing Address - Fax:
Practice Address - Street 1:2226 S MOONEY BLVD
Practice Address - Street 2:SUITE A7
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-622-9119
Practice Address - Fax:559-622-9422
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT185850Medicaid
CAZZZ250892OtherWALK ABOUT HEALTH
CA4709020001Medicare ID - Type Unspecified