=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548706021
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN RAMEY PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2017
-----------------------------------------------------
Last Update Date | 01/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7700 EDGEWATER DR SUITE 225
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94621-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-638-8033
-----------------------------------------------------
Fax | 510-638-8034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1556 SOLITUDE WAY
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94513-5145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-348-3081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | AT5300
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------