Provider Demographics
NPI:1144329053
Name:SIMUNOVIC, BLASENKO (PT)
Entity type:Individual
Prefix:
First Name:BLASENKO
Middle Name:
Last Name:SIMUNOVIC
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2976
Mailing Address - Country:US
Mailing Address - Phone:559-438-4300
Mailing Address - Fax:559-438-4339
Practice Address - Street 1:7033 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2976
Practice Address - Country:US
Practice Address - Phone:559-438-4300
Practice Address - Fax:559-438-4339
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT128052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT128050Medicare PIN
CAZZZ25912ZMedicare PIN
CAZZZ25912ZMedicare PIN
CADA6172OtherMEDICARE RAILROAD #