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General NPI Number Information
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NPI Number | 1295827723
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Entity Type | Organization
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Legal Business Name | HOME AGAIN PHYSICAL THERAPY, PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6098 N ROCKRIDGE BLVD
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City | OAKLAND
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State | CA
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Zip | 94618-1811
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Country | US
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Telephone | 510-653-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 6098 N ROCKRIDGE BLVD
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City | OAKLAND
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State | CA
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Zip | 94618-1811
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Country | US
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Telephone | 510-653-4100
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST /CEO
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Name | CLARICE O'REILLY CUMMINS
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Credential | R.P.T.
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Telephone | 510-653-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 17326
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License Number State | CA
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