Provider Demographics
NPI:1679759203
Name:TAYLOR & THORNBURG PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:TAYLOR & THORNBURG PHYSICAL THERAPY, INC.
Other - Org Name:FYZICAL THERAPY & BALANCE CTR OAKLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER OF CORPORATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:THORNBURG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:510-893-8878
Mailing Address - Street 1:3718 GRAND AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1544
Mailing Address - Country:US
Mailing Address - Phone:510-893-8878
Mailing Address - Fax:510-893-8879
Practice Address - Street 1:3718 GRAND AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1544
Practice Address - Country:US
Practice Address - Phone:510-893-8878
Practice Address - Fax:510-893-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ 07432 ZOtherMEDICARE PTAN