Healthcare Provider Details

I. General information

NPI: 1730480633
Provider Name (Legal Business Name): NEURO WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 UNIVERSITY AVE
BERKELEY CA
94702-1711
US

IV. Provider business mailing address

1356 UNIVERSITY AVE
BERKELEY CA
94702-1711
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-5537
  • Fax: 510-845-5537
Mailing address:
  • Phone: 510-845-5537
  • Fax: 510-845-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT17507
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT5695
License Number StateCA

VIII. Authorized Official

Name: PAMELA RENEE INBAR-HANSEN
Title or Position: PHYSICAL THERAPIST
Credential: MSPT
Phone: 510-845-5537