Provider Demographics
NPI:1124395819
Name:MAYO, JON SIMON (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:SIMON
Last Name:MAYO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 3RD AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1783
Mailing Address - Country:US
Mailing Address - Phone:360-378-7891
Mailing Address - Fax:
Practice Address - Street 1:1814 FRANKLIN ST
Practice Address - Street 2:905
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3487
Practice Address - Country:US
Practice Address - Phone:510-893-7463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383382251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic