Healthcare Provider Details

I. General information

NPI: 1790014405
Provider Name (Legal Business Name): MIKEL CHAD DELAND PT, DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 E CHAMPLAIN DR
FRESNO CA
93720-5624
US

IV. Provider business mailing address

701 W CENTER AVE
VISALIA CA
93291-6015
US

V. Phone/Fax

Practice location:
  • Phone: 559-878-4595
  • Fax: 559-389-0495
Mailing address:
  • Phone: 559-713-6806
  • Fax: 559-713-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number36029
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT36029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: