Provider Demographics
NPI:1699824557
Name:BAY MTU
Entity Type:Organization
Organization Name:BAY MTU
Other - Org Name:ALAMEDA COUNTY CCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:510-267-3278
Mailing Address - Street 1:1000 BROADWAY
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4099
Mailing Address - Country:US
Mailing Address - Phone:510-267-3278
Mailing Address - Fax:510-268-7110
Practice Address - Street 1:2001 BOCKMAN RD
Practice Address - Street 2:BAY SCHOOL, ROOM 25
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-1903
Practice Address - Country:US
Practice Address - Phone:510-317-4355
Practice Address - Fax:510-278-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2251P0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACCS00034FOtherCCS PROVIDER NUMBER