Provider Demographics
NPI:1922157122
Name:ASSAF, PHILIP DAVID JR (PT)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:DAVID
Last Name:ASSAF
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1440 168TH AVE
Mailing Address - Street 2:DEPARTMENT OF REHABILITATION
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2409
Mailing Address - Country:US
Mailing Address - Phone:510-481-6326
Mailing Address - Fax:
Practice Address - Street 1:1440 168TH AVE
Practice Address - Street 2:DEPARTMENT OF REHABILITATION SERVICES
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578
Practice Address - Country:US
Practice Address - Phone:510-481-6326
Practice Address - Fax:510-481-6327
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist