Organization
C O R E PHYSICAL THERAPY OF VISALIA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN R PACILLAS MPT (CEO)
(559) 679-2797
Entity
Organization
Contact information
Practice address
1138 N CHINOWTH ST, VISALIA, CA 93291
(559) 713-1222
(559) 713-1234
Mailing address
1138 N CHINOWTH ST, VISALIA, CA 93291-4113
(559) 713-1222
(559) 713-1234
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT22909
CA
2251X0800X
Orthopedic Physical Therapist
PT22909
CA
231H00000X
Audiologist
SP9406
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ64366Z
BLUE SHIELD
CA
Enumeration date
12/06/2006
Last updated
08/16/2018
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