Healthcare Provider Details

I. General information

NPI: 1639477292
Provider Name (Legal Business Name): PHILLIP TATSUYA DOBASHI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 MOWRY SCHOOL RD STE 305
NEWARK CA
94560-5371
US

IV. Provider business mailing address

4205 SAN FELIPE RD STE 100
SAN JOSE CA
95135-1546
US

V. Phone/Fax

Practice location:
  • Phone: 510-651-9258
  • Fax:
Mailing address:
  • Phone: 408-841-7203
  • Fax: 408-841-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number37561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: