MEDICARE: FRESNO SPECIALIZED SPINE & PHYSICAL THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT25621	CA

General Provider Information

NPI Number	:	1790867430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESNO SPECIALIZED SPINE & PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	5066 N FRESNO ST
Second Line	:	SUITE 106
City	:	FRESNO
State	:	CA
Zip	:	93710-7615
Country	:	US
Telephone Number	:	559-241-7200
Fax Number	:	559-241-7272

Provider Business Practice Location Address
First Line	:	5066 N FRESNO ST
Second Line	:	SUITE 106
City	:	FRESNO
State	:	CA
Zip	:	93710-7615
Country	:	US
Telephone Number	:	559-241-7200
Fax Number	:	559-241-7272

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL T MUKAI
Credential	:	PT
Telephone Number	:	559-241-7200

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	08/22/2020

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