Healthcare Provider Details

I. General information

NPI: 1376575837
Provider Name (Legal Business Name): RASCAL CREEK PHYSICAL THERAPY A PROFESSIONAL CORPORATION.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3327 M ST SUITE A
MERCED CA
95348-2705
US

IV. Provider business mailing address

3327 M ST SUITE A
MERCED CA
95348-2714
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-1030
  • Fax: 209-722-5408
Mailing address:
  • Phone: 209-722-1030
  • Fax: 209-722-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO HERNANDEZ
Title or Position: PRESIDENT
Credential: PT
Phone: 209-722-1030