Provider Demographics
NPI:1861635146
Name:VALLEY MEDICAL THERAPY UNIT
Entity Type:Organization
Organization Name:VALLEY MEDICAL THERAPY UNIT
Other - Org Name:ALAMEDA COUNTY CALIFORNIA CHILDREN'S SERVICES VALLEY MTU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF THERAPIST
Authorized Official - Prefix:MS
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 1:1040 FLORENCE RD
Practice Address - Street 2:ROOM 7
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-5543
Practice Address - Country:US
Practice Address - Phone:925-449-4163
Practice Address - Fax:925-449-4169
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALAMEDA COUNTY CALIFORNIA CHILDREN'S SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation