Healthcare Provider Details

I. General information

NPI: 1184649998
Provider Name (Legal Business Name): JOANN H. DOHALLOW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 CITRUS CIR SUITE 240
WALNUT CREEK CA
94598-2666
US

IV. Provider business mailing address

3075 CITRUS CIR SUITE 240
WALNUT CREEK CA
94598-2666
US

V. Phone/Fax

Practice location:
  • Phone: 925-930-6680
  • Fax: 925-930-7867
Mailing address:
  • Phone: 925-930-6680
  • Fax: 925-930-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT7832
License Number StateCA

VIII. Authorized Official

Name: JOANN H. DOHALLOW
Title or Position: PHYSICAL THERAPIST
Credential: PHYSICAL THERAPIST
Phone: 925-930-6680