Healthcare Provider Details

I. General information

NPI: 1306139209
Provider Name (Legal Business Name): GREGORY OHANESSIAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PORTOLA RD
PORTOLA VALLEY CA
94028-7852
US

IV. Provider business mailing address

166 SPRINGFIELD DR.
SAN FRANCISCO CA
94132
US

V. Phone/Fax

Practice location:
  • Phone: 650-851-1145
  • Fax:
Mailing address:
  • Phone: 415-420-7623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number37823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: