Healthcare Provider Details

I. General information

NPI: 1033855218
Provider Name (Legal Business Name): ALYSE ARENTZ PT, DPT, MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 CLOVIS AVE
CLOVIS CA
93612-1116
US

IV. Provider business mailing address

1671 E SHEA DR
FRESNO CA
93720-1431
US

V. Phone/Fax

Practice location:
  • Phone: 559-650-0345
  • Fax:
Mailing address:
  • Phone: 559-681-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000050499
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: