MEDICARE: RASCAL CREEK PHYSICAL THERAPY A PROFESSIONAL CORPORATION.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1376575837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RASCAL CREEK PHYSICAL THERAPY A PROFESSIONAL CORPORATION.

Provider Business Mailing Address
First Line	:	3327 M ST
Second Line	:	SUITE A
City	:	MERCED
State	:	CA
Zip	:	95348-2714
Country	:	US
Telephone Number	:	209-722-1030
Fax Number	:	209-722-5408

Provider Business Practice Location Address
First Line	:	3327 M ST
Second Line	:	SUITE A
City	:	MERCED
State	:	CA
Zip	:	95348-2705
Country	:	US
Telephone Number	:	209-722-1030
Fax Number	:	209-722-5408

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTONIO HERNANDEZ
Credential	:	PT
Telephone Number	:	209-722-1030

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	02/05/2015

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