Healthcare Provider Details

I. General information

NPI: 1770039703
Provider Name (Legal Business Name): KAWEAH REHAB GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S AKERS ST
VISALIA CA
93277-8309
US

IV. Provider business mailing address

PO BOX 6236
VISALIA CA
93290-6236
US

V. Phone/Fax

Practice location:
  • Phone: 559-300-9777
  • Fax: 559-750-4777
Mailing address:
  • Phone: 559-300-9777
  • Fax: 559-750-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA143883
License Number StateCA

VIII. Authorized Official

Name: ASHRAF GHALY
Title or Position: PARTNER
Credential: MD
Phone: 559-300-9777