Healthcare Provider Details

I. General information

NPI: 1679759203
Provider Name (Legal Business Name): TAYLOR & THORNBURG PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3718 GRAND AVE SUITE 15
OAKLAND CA
94610-1544
US

IV. Provider business mailing address

3718 GRAND AVE SUITE 15
OAKLAND CA
94610-1544
US

V. Phone/Fax

Practice location:
  • Phone: 510-893-8878
  • Fax: 510-893-8879
Mailing address:
  • Phone: 510-893-8878
  • Fax: 510-893-8879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHRYN SMITH THORNBURG
Title or Position: OFFICER OF CORPORATION
Credential: P.T.
Phone: 510-893-8878