Healthcare Provider Details

I. General information

NPI: 1699528075
Provider Name (Legal Business Name): BRIAN C TAI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W ROUTE 66 STE N
GLENDORA CA
91740-4164
US

IV. Provider business mailing address

9155 GARIBALDI AVE
TEMPLE CITY CA
91780-1624
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-4077
  • Fax:
Mailing address:
  • Phone: 626-354-6656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305814
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: