Healthcare Provider Details

I. General information

NPI: 1477605061
Provider Name (Legal Business Name): ALL SPORTS THERAPY ATHLETIC REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N. DOWTY ST.
HANFORD CA
93232
US

IV. Provider business mailing address

P.O. BOX 602
HANFORD CA
93232
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-9323
  • Fax: 559-582-0249
Mailing address:
  • Phone: 559-582-9323
  • Fax: 559-582-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT13939
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DARLENE MARGARET AYERS
Title or Position: BUS MANAGER
Credential:
Phone: 559-582-9323