Healthcare Provider Details

I. General information

NPI: 1497963664
Provider Name (Legal Business Name): DASH THERAPY A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 S. COURT ST SUITE C
VISALIA CA
93277-5469
US

IV. Provider business mailing address

1827 S COURT ST SUITE C
VISALIA CA
93277-5469
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-3274
  • Fax: 559-627-3284
Mailing address:
  • Phone: 559-627-3274
  • Fax: 559-627-3284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberBL021941
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1497963664
License Number StateCA

VIII. Authorized Official

Name: MRS. KIMBERLY CARTER GLICK
Title or Position: SECRETARY/TREASURER
Credential: CHT
Phone: 559-627-3274