Provider Demographics
NPI:1760923478
Name:WOMEN'S HEALTH AND HEALING PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH AND HEALING PHYSICAL THERAPY, INC
Other - Org Name:WOMEN'S HEALTH AND HEALING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-255-3865
Mailing Address - Street 1:250 LAFAYETTE CIR STE 107
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4389
Mailing Address - Country:US
Mailing Address - Phone:510-255-3865
Mailing Address - Fax:
Practice Address - Street 1:250 LAFAYETTE CIR STE 107
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4389
Practice Address - Country:US
Practice Address - Phone:510-255-3865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35702261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy