Provider Demographics
NPI:1043314131
Name:BERKELEY PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:BERKELEY PHYSICAL THERAPY INC
Other - Org Name:BERKELEY PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:YAMADA
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:510-549-2225
Mailing Address - Street 1:2041 BANCROFT WAY
Mailing Address - Street 2:STE 301
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704
Mailing Address - Country:US
Mailing Address - Phone:510-549-2225
Mailing Address - Fax:510-549-0741
Practice Address - Street 1:2041 BANCROFT WAY
Practice Address - Street 2:STE 301
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-549-2225
Practice Address - Fax:510-549-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00PT85690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R27127Medicare UPIN
CAZZZ18259ZMedicare ID - Type Unspecified