Provider Demographics
NPI:1346436318
Name:LO, TONY Y (PTA)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:Y
Last Name:LO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8814 OLIVER PL.
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94569
Mailing Address - Country:US
Mailing Address - Phone:415-254-6598
Mailing Address - Fax:
Practice Address - Street 1:8814 OLIVER PL.
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94569
Practice Address - Country:US
Practice Address - Phone:415-254-6598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 6324225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant