Healthcare Provider Details

I. General information

NPI: 1184669756
Provider Name (Legal Business Name): PHYSICAL THERAPY INNOVATIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 KEARNEY ST
EL CERRITO CA
94530-3656
US

IV. Provider business mailing address

425 KEARNEY ST
EL CERRITO CA
94530-3656
US

V. Phone/Fax

Practice location:
  • Phone: 510-524-2177
  • Fax: 510-525-2875
Mailing address:
  • Phone: 510-524-2177
  • Fax: 510-525-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ALLEN L LING
Title or Position: CEO, DIRECTOR, OWNER
Credential: MPT
Phone: 510-524-2177