Healthcare Provider Details

I. General information

NPI: 1407660509
Provider Name (Legal Business Name): MVP PHYSICAL THERAPY AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 CLEMENT AVE
ALAMEDA CA
94501-1205
US

IV. Provider business mailing address

2601 BLANDING AVE STE C-241
ALAMEDA CA
94501-1579
US

V. Phone/Fax

Practice location:
  • Phone: 510-910-2619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREA LONG
Title or Position: OWNER
Credential: MPT, CSCS
Phone: 510-910-2619