Provider Demographics
NPI:1982605903
Name:BESONIS, JOHN CHRIS (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHRIS
Last Name:BESONIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:CHRISTAIN
Other - Last Name:BESONIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1739
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602
Mailing Address - Country:US
Mailing Address - Phone:512-708-0803
Mailing Address - Fax:
Practice Address - Street 1:165 N REDWOOD DR
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1969
Practice Address - Country:US
Practice Address - Phone:415-499-0278
Practice Address - Fax:415-499-0297
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1181020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT298680Medicare ID - Type UnspecifiedPROVIDER NUMBER