Healthcare Provider Details

I. General information

NPI: 1043773385
Provider Name (Legal Business Name): BERKELEY COMMUNITY PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 UNIVERSITY AVE
BERKELEY CA
94703-1516
US

IV. Provider business mailing address

1834 UNIVERSITY AVE
BERKELEY CA
94703-1516
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-2225
  • Fax: 510-549-0741
Mailing address:
  • Phone: 510-549-2225
  • Fax: 510-549-0741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: NEGEENE MOSAED
Title or Position: PROPRIETOR
Credential: PT
Phone: 510-549-2225