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NPI 1316454200ActiveIndividual· Physical Therapist· Willows, CA
Physical Therapist in Willows, California, licensed in CA, with an NPI issued in January 2018. Enrolled in Medicare as practitioner - physical therapist in private practice.
Overview
| NPI | 1316454200 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | No |
| NPI issued | Jan 2, 2018 |
| Last updated in NPPES | Jul 24, 2020 |
| Certified by provider | Jul 24, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | 294104 | CA |
| Physical Therapist | 225100000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (CA) |
|---|
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