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General NPI Number Information
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NPI Number | 1407073059
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Entity Type | Individual
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Provider Name | EDARLENE ROMERO FAMISAN PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5180 N PALM AVE STE 102
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City | FRESNO
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State | CA
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Zip | 93704-2230
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Country | US
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Telephone | 559-244-0394
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Fax |
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Provider Business Mailing Address
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Address Line | 5665 N FRESNO ST APT 215
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City | FRESNO
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State | CA
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Zip | 93710-6058
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Country | US
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Telephone | 310-218-7695
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Fax |
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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 | PT 32929
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License Number State | CA
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