1861503435 NPI number — TAYLOR & THORNBURG PHYSICAL THERAPY

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 1861503435 NPI number — TAYLOR & THORNBURG PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAYLOR & THORNBURG PHYSICAL THERAPY
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:
1861503435
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
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:
519-892-8879

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:
519-892-8879
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
CAROLINE
Authorized Official Middle Name:
DRYE
Authorized Official Title or Position:
PARTNER/ CO-OWNER
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)





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