Healthcare Provider Details

I. General information

NPI: 1578547295
Provider Name (Legal Business Name): MARIA THERESA JOHANSSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20996 REDWOOD RD
CASTRO VALLEY CA
94546-5918
US

IV. Provider business mailing address

20996 REDWOOD RD
CASTRO VALLEY CA
94546-5918
US

V. Phone/Fax

Practice location:
  • Phone: 510-537-0272
  • Fax: 510-537-5819
Mailing address:
  • Phone: 510-537-0272
  • Fax: 510-537-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: