Healthcare Provider Details

I. General information

NPI: 1922157890
Provider Name (Legal Business Name): GLANKLER MTU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39207 SUNDALE DR
FREMONT CA
94538-1916
US

IV. Provider business mailing address

1000 BROADWAY 5TH FLOOR
OAKLAND CA
94607-4099
US

V. Phone/Fax

Practice location:
  • Phone: 510-651-1312
  • Fax: 510-661-0472
Mailing address:
  • Phone: 510-267-3278
  • Fax: 510-268-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: SUSAN L JOHNSON
Title or Position: CHIEF THERAPIST
Credential: PT
Phone: 510-267-3278