Healthcare Provider Details

I. General information

NPI: 1144132465
Provider Name (Legal Business Name): GEORDAN THURSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 BOULEVARD WAY STE 2
PIEDMONT CA
94610-1563
US

IV. Provider business mailing address

1777 CLEMENT AVE APT 131
ALAMEDA CA
94501-7981
US

V. Phone/Fax

Practice location:
  • Phone: 510-922-8872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: