Healthcare Provider Details

I. General information

NPI: 1396216537
Provider Name (Legal Business Name): CARTNEY DZOAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/08/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2587 MERCED ST
SAN LEANDRO CA
94577-4207
US

IV. Provider business mailing address

227 IMPERIO AVE
FREMONT CA
94539-3114
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number296064
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: