Healthcare Provider Details

I. General information

NPI: 1871106963
Provider Name (Legal Business Name): WILLIAM LEONARDO MCCOMBS JR. PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7275 N FIRST STREET SUITE 206
FRESNO CA
93720-2977
US

IV. Provider business mailing address

7275 N FIRST STREET SUITE 206
FRESNO CA
93720-2977
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-6700
  • Fax: 559-431-6777
Mailing address:
  • Phone: 559-431-6700
  • Fax: 559-431-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA50739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: