Provider Demographics
NPI:1538154273
Name:FEHRENBACH, CHARLES JOSEPH (PT, AT, C)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:FEHRENBACH
Suffix:
Gender:M
Credentials:PT, AT, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BERLAMO
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2656
Mailing Address - Country:US
Mailing Address - Phone:949-586-2537
Mailing Address - Fax:
Practice Address - Street 1:26034 ACERO BLDG K
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-837-9074
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT16850Medicare ID - Type UnspecifiedMEDICARE NUMBER