Healthcare Provider Details

I. General information

NPI: 1295501062
Provider Name (Legal Business Name): AMBER RACHELLE REUSCH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7033 N FRESNO ST STE 202
FRESNO CA
93720-2976
US

IV. Provider business mailing address

112 MISSION DR S
MADERA CA
93636-8186
US

V. Phone/Fax

Practice location:
  • Phone: 559-438-4300
  • Fax:
Mailing address:
  • Phone: 209-777-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number49507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: