Provider Demographics
NPI:1750443669
Name:OSTEOLIFE
Entity Type:Organization
Organization Name:OSTEOLIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:925-487-1025
Mailing Address - Street 1:1800 MELVIN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2025
Mailing Address - Country:US
Mailing Address - Phone:925-487-1025
Mailing Address - Fax:925-931-0778
Practice Address - Street 1:1800 MELVIN RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-2025
Practice Address - Country:US
Practice Address - Phone:925-487-1025
Practice Address - Fax:925-931-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty