Healthcare Provider Details

I. General information

NPI: 1346600418
Provider Name (Legal Business Name): FOUNDATIONS THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CONTINENTE AVE SUITE 100
BRENTWOOD CA
94513
US

IV. Provider business mailing address

2283 SPARTAN TER
BRENTWOOD CA
94513-5924
US

V. Phone/Fax

Practice location:
  • Phone: 925-513-2440
  • Fax:
Mailing address:
  • Phone: 925-634-8372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number1215
License Number StateCA

VIII. Authorized Official

Name: JULIE ZITO
Title or Position: PRESIDENT
Credential: OTR
Phone: 925-513-2440