Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT15431 | CA |
N | 2251E1200X | Ergonomics | ||
N | 225XE1200X | Ergonomics |
NPI | 1386858959 |
---|---|
Provider Name | Charles T Spina |
First Address | Fresno, CA 93710-3945 |
Second Address | Fresno, CA 93720-8009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 02/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CK761U | MEDICARE PTAN (01) | CA |
ZZZ18195Z | (02) | CA |
ZZZ32774Z | (02) | CA |