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NPI Code Detail

MEDICARE: CHRISTINE ELY M.P.T.

MEDICARE: CHRISTINE ELY M.P.T.
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
1174400000XSpecialistPT18744CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT18744OTHERCALICENSE #

General Provider Information

NPI Number : 1811965841
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE ELY M.P.T.
Provider Business Mailing Address
First Line : 785 MAIN ST
Second Line : SUITE A
City : HALF MOON BAY
State : CA
Zip : 94019
Country : US
Telephone Number : 650-712-8400
Fax Number : 650-712-8600
Provider Business Practice Location Address
First Line : 785 MAIN ST
Second Line :
City : HALF MOON BAY
State : CA
Zip : 94019-1992
Country : US
Telephone Number : 650-712-8400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 10/07/2008

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Directions to “ CHRISTINE ELY M.P.T.” Practice Location

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