Healthcare Provider Details

I. General information

NPI: 1013936475
Provider Name (Legal Business Name): ROBERT MICHAEL BACCI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 W HILLSDALE AVE SUITE A
VISALIA CA
93291-5138
US

IV. Provider business mailing address

PO BOX 7779
VISALIA CA
93290-7779
US

V. Phone/Fax

Practice location:
  • Phone: 559-733-2478
  • Fax: 559-733-2470
Mailing address:
  • Phone: 559-733-2478
  • Fax: 559-733-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6969
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT6969
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License NumberPT6969
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT6969
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT6969
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT6969
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT6969
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License NumberPT6969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: