Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT6969 | CA |
N | 2251E1200X | Ergonomics | PT6969 | CA |
N | 225XE1200X | Ergonomics | PT6969 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT6969 | CA |
N | 2251H1200X | Hand | PT6969 | CA |
N | 2251N0400X | Physical Therapist - Neurology | PT6969 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT6969 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT6969 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT6969 | CA |
NPI | 1013936475 |
---|---|
Provider Name | Mr. Robert Michael Bacci |
First Address | Visalia, CA 93290-7779 |
Second Address | Visalia, CA 93291-5138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 04/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00PT69690 | (05) | CA |
00PT69690 | BLUE CROSS (01) | CA |
00PT69690 | BLUE SHIELD (01) | CA |
R26714 | (02) |