Provider Demographics
NPI:1346243128
Name:OSTERTAG, RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:OSTERTAG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 PILGRIM DR
Mailing Address - Street 2:STE B
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1211
Mailing Address - Country:US
Mailing Address - Phone:650-571-6800
Mailing Address - Fax:650-571-1260
Practice Address - Street 1:557 PILGRIM DR
Practice Address - Street 2:STE B
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1211
Practice Address - Country:US
Practice Address - Phone:650-571-6800
Practice Address - Fax:650-571-1260
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOPT284970Medicare ID - Type Unspecified