Provider Demographics
NPI:1619685013
Name:GU, JOEY (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:GU
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-2758
Mailing Address - Country:US
Mailing Address - Phone:510-882-1736
Mailing Address - Fax:
Practice Address - Street 1:435 BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-2758
Practice Address - Country:US
Practice Address - Phone:510-882-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist