Healthcare Provider Details

I. General information

NPI: 1699933259
Provider Name (Legal Business Name): ELIZABETH DEBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 PINE ST
SAN FRANCISCO CA
94109-4807
US

IV. Provider business mailing address

11 CASTRO ST
SAN FRANCISCO CA
94114-1008
US

V. Phone/Fax

Practice location:
  • Phone: 415-673-8405
  • Fax: 415-771-8906
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: