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General NPI Number Information
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NPI Number | 1992804678
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Entity Type | Organization
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Legal Business Name | NOVA CARE
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2160 APPIAN WAY 101
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City | PINOLE
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State | CA
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Zip | 94564-2576
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Country | US
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Telephone | 510-724-1248
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 EVELYN AVE
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City | ALBANY
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State | CA
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Zip | 94706-2316
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Country | US
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Telephone | 510-559-3169
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Fax |
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Authorized Official
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Title or Position | MANAGER OF CLINICAL OPERATION
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Name | MR. GEORGE RAILTON
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Credential | PT,MHA
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Telephone | 510-724-1248
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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 | 32883
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License Number State | CA
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