Healthcare Provider Details

I. General information

NPI: 1801272992
Provider Name (Legal Business Name): PREMIUM PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 HERNDON AVE STE. 102
CLOVIS CA
93611-6101
US

IV. Provider business mailing address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

V. Phone/Fax

Practice location:
  • Phone: 559-321-8405
  • Fax: 559-900-7952
Mailing address:
  • Phone: 559-436-6228
  • Fax: 559-436-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL SHAWN BIGGERS
Title or Position: OWNER
Credential: DPT
Phone: 559-321-8405