Healthcare Provider Details

I. General information

NPI: 1568186187
Provider Name (Legal Business Name): THERAPYDIA CALIFORNIA PHYSICAL THERAPY, PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 NW NORMAN AVE
GRESHAM OR
97030-5551
US

IV. Provider business mailing address

18 E BLITHEDALE AVE STE 21
MILL VALLEY CA
94941-1946
US

V. Phone/Fax

Practice location:
  • Phone: 971-362-3288
  • Fax: 971-353-4990
Mailing address:
  • Phone: 415-533-4863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LEAH NOTTINGHAM
Title or Position: CPO
Credential:
Phone: 415-389-8677