Provider Demographics
NPI:1588205587
Name:NATIV, OR (PT, CSCS)
Entity type:Individual
Prefix:
First Name:OR
Middle Name:
Last Name:NATIV
Suffix:
Gender:M
Credentials:PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 DAVID ST APT 112
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1911
Mailing Address - Country:US
Mailing Address - Phone:650-796-4048
Mailing Address - Fax:
Practice Address - Street 1:2322 POWELL ST
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1738
Practice Address - Country:US
Practice Address - Phone:510-653-5151
Practice Address - Fax:510-601-1358
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist