Basic Information
Provider Information
NPI: 1295110955
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZAMPESE
FirstName: FERIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ZAMPESE-SKINNER
OtherFirstName: FERIN
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: P.T.
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 905
Address2:  
City: ORANGE
State: CA
PostalCode: 928566905
CountryCode: US
TelephoneNumber: 7146344567
FaxNumber: 7146344569
Practice Location
Address1: 280 S MAIN ST
Address2: STE 200
City: ORANGE
State: CA
PostalCode: 928683852
CountryCode: US
TelephoneNumber: 7146344567
FaxNumber: 7146344569
Other Information
ProviderEnumerationDate: 07/23/2015
LastUpdateDate: 07/23/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251X0800XPT29422CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


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