Healthcare Provider Details

I. General information

NPI: 1932016805
Provider Name (Legal Business Name): NURTURLY KIDS PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 GUM ST
SAN MATEO CA
94402-3027
US

IV. Provider business mailing address

1900 S NORFOLK ST STE 350
SAN MATEO CA
94403-1171
US

V. Phone/Fax

Practice location:
  • Phone: 415-816-6726
  • Fax:
Mailing address:
  • Phone: 415-816-6726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER LIU
Title or Position: OWNER
Credential:
Phone: 415-816-6726