Healthcare Provider Details

I. General information

NPI: 1023596616
Provider Name (Legal Business Name): BRIAN PAUL KHAL DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 N WEST AVE STE 101A
FRESNO CA
93711-1399
US

IV. Provider business mailing address

701 W CENTER AVE
VISALIA CA
93291-6015
US

V. Phone/Fax

Practice location:
  • Phone: 559-878-4266
  • Fax: 559-283-8746
Mailing address:
  • Phone: 559-713-6806
  • Fax: 559-713-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304479
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: