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Organization
PHYS MED INC.
Active
Organization
PHYS MED INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLASENKO H SIMUNOVIC PT (PRESIDENT/CEO)
(559) 438-4300
Entity
Organization
Contact information
Practice address
201 S MADERA AVE, #100, KERMAN, CA 93630-1129
(559) 846-6336
(559) 846-3344
Mailing address
7033 N FRESNO ST, #302, FRESNO, CA 93720-2976
(559) 438-4300
(559) 438-4339
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 12805
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056629
MEDICARE PTAN
CA
Enumeration date
05/13/2014
Last updated
05/13/2014
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