Healthcare Provider Details

I. General information

NPI: 1396169090
Provider Name (Legal Business Name): EARL FRIEND IV DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2014
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PENNY LN STE 4
WATSONVILLE CA
95076-6008
US

IV. Provider business mailing address

1182 SAGARDIA WAY
GILROY CA
95020-7153
US

V. Phone/Fax

Practice location:
  • Phone: 831-763-4444
  • Fax:
Mailing address:
  • Phone: 510-388-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number41269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: