Healthcare Provider Details

I. General information

NPI: 1184706368
Provider Name (Legal Business Name): ANDREW TAI P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 UNIVERSITY AVE
SACRAMENTO CA
95825-6708
US

IV. Provider business mailing address

PO BOX 612260
SAN JOSE CA
95161-2260
US

V. Phone/Fax

Practice location:
  • Phone: 916-927-1333
  • Fax: 916-927-1586
Mailing address:
  • Phone: 877-325-2776
  • Fax: 408-945-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 25014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: