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General NPI Number Information
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NPI Number | 1073094579
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Entity Type | Organization
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Legal Business Name | CORE PHYSICAL THERAPY BY BRYAN PACILLAS PC
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 1136 N CHINOWTH ST
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City | VISALIA
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State | CA
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Zip | 93291-4113
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Country | US
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Telephone | 559-671-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 2643 N CHINOWTH ST
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City | VISALIA
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State | CA
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Zip | 93291-8077
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Country | US
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Telephone | 559-679-2797
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRYAN R PACILLAS
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Credential |
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Telephone | 559-671-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 22909
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License Number State | CA
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