Provider Demographics
NPI:1891880043
Name:LAM, JEFF (PT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 BRANNAN ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-6026
Mailing Address - Country:US
Mailing Address - Phone:650-888-8872
Mailing Address - Fax:
Practice Address - Street 1:200 BRANNAN STREET
Practice Address - Street 2:SUITE 340
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-6011
Practice Address - Country:US
Practice Address - Phone:650-888-8872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGPT001060Medicaid
CAGPT001060Medicaid