Provider Demographics
NPI:1811241938
Name:THERASPORT PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:THERASPORT PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:734-765-3171
Mailing Address - Street 1:4930 W KAWEAH CT
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4930 W KAWEAH CT
Practice Address - Street 2:SUITE 204
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8324
Practice Address - Country:US
Practice Address - Phone:559-836-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty