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General NPI Number Information
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NPI Number | 1487074977
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Entity Type | Organization
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Legal Business Name | ST MARY PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 432 S CHURCH ST
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City | VISALIA
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State | CA
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Zip | 93277-2703
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Country | US
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Telephone | 516-406-4898
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7270
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City | VISALIA
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State | CA
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Zip | 93290-7270
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Country | US
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Telephone | 516-406-4898
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MR. SAMEH M NASR
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Credential | PT
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Telephone | 516-406-4898
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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 | 40211
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License Number State | CA
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