Organization
PREMIUM PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL SHAWN BIGGERS DPT (OWNER)
(559) 321-8405
Entity
Organization
Contact information
Practice address
2021 HERNDON AVE, STE. 102, CLOVIS, CA 93611-6101
(559) 321-8405
(559) 900-7952
Mailing address
7471 N FRESNO ST, FRESNO, CA 93720-2457
(559) 436-6228
(559) 436-0500
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
261QP2000X
TAXONOMY
CA
Enumeration date
07/30/2015
Last updated
07/26/2016
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