Provider Demographics
NPI:1801272992
Name:PREMIUM PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:PREMIUM PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:BIGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:559-321-8405
Mailing Address - Street 1:7471 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2457
Mailing Address - Country:US
Mailing Address - Phone:559-436-6228
Mailing Address - Fax:559-436-0500
Practice Address - Street 1:2021 HERNDON AVE
Practice Address - Street 2:STE. 102
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6101
Practice Address - Country:US
Practice Address - Phone:559-321-8405
Practice Address - Fax:559-900-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA261QP2000XOtherTAXONOMY