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General NPI Number Information
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NPI Number | 1376817684
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Entity Type | Individual
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Provider Name | CHAD BRANDON RIECKENBERG DPT
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Gender | Male
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 1209 WHITLEY AVE
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City | CORCORAN
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State | CA
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Zip | 93212-2327
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Country | US
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Telephone | 559-216-0595
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Fax | 559-762-7592
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Provider Business Mailing Address
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Address Line | 7033 N FRESNO ST STE 202
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City | FRESNO
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State | CA
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Zip | 93720-2976
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Country | US
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Telephone | 559-438-4300
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Fax | 559-438-4339
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 38789
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License Number State | CA
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