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General NPI Number Information
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NPI Number | 1144536574
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE MEDICAL REHABILITATION INC
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Dates
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Enumeration Date | 08/23/2010
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 7030 BUCKINGHAM BLVD
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City | BERKELEY
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State | CA
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Zip | 94705-1713
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Country | US
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Telephone | 510-964-0458
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Fax |
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Provider Business Mailing Address
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Address Line | 7030 BUCKINGHAM BLVD
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City | BERKELEY
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State | CA
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Zip | 94705-1713
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Country | US
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Telephone | 510-964-0458
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Fax | 510-964-0476
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Authorized Official
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Title or Position | PRINCIPAL OFFICER
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Name | KATHY A ELGOHARY
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Credential |
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Telephone | 510-964-0458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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