Healthcare Provider Details

I. General information

NPI: 1083685333
Provider Name (Legal Business Name): BAY AREA PHYSICAL THERAPY OF BENICIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 1ST ST SUITE D-101
BENICIA CA
94510-3295
US

IV. Provider business mailing address

560 1ST ST SUITE D-101
BENICIA CA
94510-3295
US

V. Phone/Fax

Practice location:
  • Phone: 707-747-9977
  • Fax:
Mailing address:
  • Phone: 707-747-9977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAY MEHTA
Title or Position: PRESIDENT
Credential:
Phone: 707-747-9977