Healthcare Provider Details

I. General information

NPI: 1164759403
Provider Name (Legal Business Name): RAYMOND J BATARA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 390 N LOOP ROAD
FORT IRWIN CA
92310
US

IV. Provider business mailing address

BLDG 390 N LOOP ROAD
FORT IRWIN CA
92310
US

V. Phone/Fax

Practice location:
  • Phone: 760-383-5550
  • Fax:
Mailing address:
  • Phone: 760-383-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6372
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT-2840
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.017281
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: