Healthcare Provider Details

I. General information

NPI: 1245518356
Provider Name (Legal Business Name): BRYANNA LAMBERJACK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
PALO ALTO CA
94305-2200
US

IV. Provider business mailing address

2220 PALERMO DR APT 11
SAN DIEGO CA
92106-1262
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-6701
  • Fax:
Mailing address:
  • Phone: 419-957-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number33192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: