Healthcare Provider Details

I. General information

NPI: 1396367645
Provider Name (Legal Business Name): PERSONAL EDGE PT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2020
Last Update Date: 05/09/2020
Certification Date: 05/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7080 DONLON WAY STE 108
DUBLIN CA
94568-2788
US

IV. Provider business mailing address

4964 ARNICA CT
SAN JOSE CA
95111-3901
US

V. Phone/Fax

Practice location:
  • Phone: 925-556-4310
  • Fax: 925-556-0375
Mailing address:
  • Phone: 208-230-5812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LEEANN MARIE PRICE
Title or Position: PRESIDENT/CLINICAL DIRECTOR
Credential: DPT
Phone: 208-230-5812