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General NPI Number Information
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NPI Number | 1689129520
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Entity Type | Individual
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Provider Name | GEORGE BRUCE HOMAN JR. PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/21/2016
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 950 OAKDALE RD STE F
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City | MODESTO
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State | CA
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Zip | 95355-4594
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Country | US
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Telephone | 209-622-1015
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Fax |
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Provider Business Mailing Address
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Address Line | 1518 COFFEE RD STE 1
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City | MODESTO
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State | CA
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Zip | 95355-3164
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Country | US
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Telephone | 209-576-0888
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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 | 2305212381
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH9238
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01584000
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT298540
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License Number State | CA
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