Provider Demographics
NPI:1861918161
Name:PRATT, CALEB N
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:N
Last Name:PRATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 W KAWEAH CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8324
Mailing Address - Country:US
Mailing Address - Phone:559-713-6806
Mailing Address - Fax:
Practice Address - Street 1:323 N 11TH AVE
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4511
Practice Address - Country:US
Practice Address - Phone:559-772-8304
Practice Address - Fax:559-530-3239
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT293466208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation