Healthcare Provider Details

I. General information

NPI: 1275624405
Provider Name (Legal Business Name): DAVID HATAE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 MT DIABLO BLVD SUITE 100
LAFAYETTE CA
94549-3588
US

IV. Provider business mailing address

PO BOX 1298
LAFAYETTE CA
94549-1298
US

V. Phone/Fax

Practice location:
  • Phone: 925-284-5300
  • Fax: 925-284-5381
Mailing address:
  • Phone: 925-284-5300
  • Fax: 925-284-5381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT18801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: