Healthcare Provider Details

I. General information

NPI: 1114983640
Provider Name (Legal Business Name): ABA PHYSICAL THERAPY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 S AMPHLETT BLVD # 123
SAN MATEO CA
94402-2512
US

IV. Provider business mailing address

1670 S AMPHLETT BLVD # 123
SAN MATEO CA
94402-2512
US

V. Phone/Fax

Practice location:
  • Phone: 650-558-0247
  • Fax: 650-558-1735
Mailing address:
  • Phone: 650-558-0247
  • Fax: 650-558-1735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010010
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT9998
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3088
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT9671
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT9940
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT9657
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24571
License Number StateCA

VIII. Authorized Official

Name: KAREN L ANDERSON
Title or Position: VP
Credential: PT
Phone: 650-558-0247