Healthcare Provider Details

I. General information

NPI: 1437551629
Provider Name (Legal Business Name): MARY BIAGINI P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14766 WASHINGTON AVE WASHINGTON CENTER
SAN LEANDRO CA
94578-4220
US

IV. Provider business mailing address

5812 ROSS ST
OAKLAND CA
94618-1630
US

V. Phone/Fax

Practice location:
  • Phone: 510-352-2211
  • Fax:
Mailing address:
  • Phone: 510-205-5224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT 1921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: