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General NPI Number Information
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NPI Number | 1750409561
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Entity Type | Organization
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Legal Business Name | PENINSULA HAND THERAPY, INC.
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 2945 JUNIPERO SERRA BLVD
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City | DALY CITY
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State | CA
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Zip | 94014-2549
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Country | US
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Telephone | 650-755-6500
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Fax | 650-755-6565
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Provider Business Mailing Address
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Address Line | 2945 JUNIPERO SERRA BLVD
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City | DALY CITY
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State | CA
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Zip | 94014-2549
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Country | US
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Telephone | 650-755-6500
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Fax | 650-755-6565
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Authorized Official
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Title or Position | OWNER HAND THERAPIST
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Name | NANCY A. PETTY
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Credential | O.T.R.,C.H.T.
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Telephone | 650-755-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | OT3395
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License Number State | CA
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