1679759203 NPI number — TAYLOR & THORNBURG PHYSICAL THERAPY, INC.

Table of content: (NPI 1679759203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679759203 NPI number — TAYLOR & THORNBURG PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAYLOR & THORNBURG PHYSICAL THERAPY, INC.
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:
6
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:
1679759203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3718 GRAND AVE
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94610-1544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-893-8878
Provider Business Mailing Address Fax Number:
510-893-8879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3718 GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94610-1544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-893-8878
Provider Business Practice Location Address Fax Number:
510-893-8879
Provider Enumeration Date:
01/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
THORNBURG
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
SMITH
Authorized Official Title or Position:
OFFICER OF CORPORATION
Authorized Official Telephone Number:
510-893-8878

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ 07432 Z . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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