Healthcare Provider Details

I. General information

NPI: 1477346245
Provider Name (Legal Business Name): ANTONINO TRIPOLI PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25919 GADING RD
HAYWARD CA
94544-2725
US

IV. Provider business mailing address

25816 FRANKLIN AVE
HAYWARD CA
94544-2828
US

V. Phone/Fax

Practice location:
  • Phone: 510-782-8424
  • Fax:
Mailing address:
  • Phone: 831-214-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number29582
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number50378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: