Individual
MICAH DIFALCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
615 4TH ST, CLOVIS, CA 93612-1124
(559) 322-5345
Mailing address
615 4TH ST, CLOVIS, CA 93612-1124
(559) 322-5345
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA50528
CA
Other
Enumeration date
02/18/2020
Last updated
02/18/2020
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