Provider Demographics
NPI:1598787244
Name:JOANN H. DOHALLOW
Entity Type:Organization
Organization Name:JOANN H. DOHALLOW
Other - Org Name:PACER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:H
Authorized Official - Last Name:DOHALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:925-930-6680
Mailing Address - Street 1:3075 CITRUS CIR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2666
Mailing Address - Country:US
Mailing Address - Phone:925-930-6680
Mailing Address - Fax:925-930-7867
Practice Address - Street 1:2330 SAN RAMON VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1608
Practice Address - Country:US
Practice Address - Phone:925-855-1733
Practice Address - Fax:925-855-1758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ16344ZMedicare PIN