Healthcare Provider Details

I. General information

NPI: 1194633479
Provider Name (Legal Business Name): OSCAR XAVIER PERALTA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 SHATTUCK AVE
BERKELEY CA
94704-3236
US

IV. Provider business mailing address

300 VERNON ST APT 37
OAKLAND CA
94610-3033
US

V. Phone/Fax

Practice location:
  • Phone: 510-705-1814
  • Fax:
Mailing address:
  • Phone: 626-483-1483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: