1568186187 NPI number — THERAPYDIA CALIFORNIA PHYSICAL THERAPY, PC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568186187 NPI number — THERAPYDIA CALIFORNIA PHYSICAL THERAPY, PC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPYDIA CALIFORNIA PHYSICAL THERAPY, PC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568186187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 E BLITHEDALE AVE STE 21
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILL VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94941-1946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-533-4863
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1027 NW NORMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRESHAM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97030-5551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-362-3288
Provider Business Practice Location Address Fax Number:
971-353-4990
Provider Enumeration Date:
09/27/2022

Additional Information

Authorized Official

Authorized Official Last Name:
NOTTINGHAM
Authorized Official First Name:
LEAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CPO
Authorized Official Telephone Number:
415-389-8677

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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