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Organization
VISALIA SPORT AND SPINE REHABILITATION CENTER INC
Active
Organization
VISALIA SPORT AND SPINE REHABILITATION CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. QUENTIN HEATH JOHNSON PT (PRESIDENT CFO CEO)
(559) 625-2777
Entity
Organization
Contact information
Practice address
3530 W MINERAL KING AVE, SUITE D, VISALIA, CA 93291
(559) 625-2777
(559) 625-3373
Mailing address
3530 W MINERAL KING AVE, SUITE D, VISALIA, CA 93291
(559) 625-2777
(559) 625-3373
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ08071Z
BLUE SHIELD
—
Enumeration date
07/30/2006
Last updated
08/22/2020
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