Healthcare Provider Details

I. General information

NPI: 1124878020
Provider Name (Legal Business Name): JOHN WINSTON MCCALL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 N FRESNO ST
FRESNO CA
93710-6006
US

IV. Provider business mailing address

4092 N CHESTNUT AVE APT 259
FRESNO CA
93726-4714
US

V. Phone/Fax

Practice location:
  • Phone: 559-430-8211
  • Fax:
Mailing address:
  • Phone: 559-203-9941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number53130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: