Provider Demographics
NPI:1689690836
Name:FLEX PHYSICAL THERAPY AND FITNESS
Entity Type:Organization
Organization Name:FLEX PHYSICAL THERAPY AND FITNESS
Other - Org Name:FLEX PHYSICAL THERAPY AND FITNESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:510-655-3060
Mailing Address - Street 1:4266 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5130
Mailing Address - Country:US
Mailing Address - Phone:510-655-3060
Mailing Address - Fax:510-655-2065
Practice Address - Street 1:4266 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5130
Practice Address - Country:US
Practice Address - Phone:510-655-3060
Practice Address - Fax:510-655-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18003OtherPHYSICAL THERAPIST
CA27339OtherPHYSICAL THERAPIST
CA23332OtherPHYSICAL THERAPIST
CA23332OtherPHYSICAL THERAPIST