Healthcare Provider Details

I. General information

NPI: 1619206927
Provider Name (Legal Business Name): ANDREW OKAMOTO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2587 MERCED ST
SAN LEANDRO CA
94577-4207
US

IV. Provider business mailing address

3465 RICHMOND BLVD APT 102
OAKLAND CA
94611-5800
US

V. Phone/Fax

Practice location:
  • Phone: 510-351-3553
  • Fax: 510-351-3585
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: