Individual
BETTY FISKUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2039 VIOLA ST, MODESTO, CA 95354-1729
(209) 581-5974
Mailing address
2039 VIOLA ST, MODESTO, CA 95354-1729
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT6229
CA
Other
Enumeration date
04/08/2011
Last updated
08/27/2024
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