Healthcare Provider Details

I. General information

NPI: 1982777066
Provider Name (Legal Business Name): PHYLLIS R. EMANUEL PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 CITRUS CIR
WALNUT CREEK CA
94598-2666
US

IV. Provider business mailing address

783 HILLDALE AVE
BERKELEY CA
94708-1317
US

V. Phone/Fax

Practice location:
  • Phone: 925-930-6680
  • Fax: 925-930-7867
Mailing address:
  • Phone: 510-527-4374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT7518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: