Healthcare Provider Details

I. General information

NPI: 1336056084
Provider Name (Legal Business Name): BREADTH PHYSICAL THERAPY & WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 KEARNEY ST
EL CERRITO CA
94530-3520
US

IV. Provider business mailing address

501 KEARNEY ST
EL CERRITO CA
94530-3520
US

V. Phone/Fax

Practice location:
  • Phone: 510-603-3424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: NINA LUU
Title or Position: FOUNDER
Credential: PT, DPT
Phone: 510-603-3424