Healthcare Provider Details

I. General information

NPI: 1699728188
Provider Name (Legal Business Name): PHYS MED A PHYSICAL THERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4969 E MCKINLEY AVE STE 106
FRESNO CA
93727-1968
US

IV. Provider business mailing address

4969 E MCKINLEY AVE STE 106
FRESNO CA
93727-1968
US

V. Phone/Fax

Practice location:
  • Phone: 559-319-1725
  • Fax:
Mailing address:
  • Phone: 559-319-1725
  • Fax: 559-478-5519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BLASENKO HUGO SIMUNOVIC
Title or Position: OWNER
Credential: P.T.
Phone: 559-438-4300