MEDICARE: EAST BAY PHYSICAL THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	22298	CA
2	225100000X	Physical Therapist	19723	CA
3	225100000X	Physical Therapist	12835	CA

General Provider Information

NPI Number	:	1437224383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST BAY PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	3571 SAN PABLO DAM RD
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94803-2727
Country	:	US
Telephone Number	:	510-222-8080
Fax Number	:	510-222-8083

Provider Business Practice Location Address
First Line	:	3571 SAN PABLO DAM RD
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94803-2727
Country	:	US
Telephone Number	:	510-222-8080
Fax Number	:	510-222-8083

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. MATTHEW MICHAEL SCERRI
Credential	:	B.S.
Telephone Number	:	510-222-8080

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	04/17/2019

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