Provider Demographics
NPI:1184806564
Name:MAYES, MURIEL (OMT RPT)
Entity type:Individual
Prefix:
First Name:MURIEL
Middle Name:
Last Name:MAYES
Suffix:
Gender:F
Credentials:OMT RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610
Mailing Address - Country:US
Mailing Address - Phone:510-385-8619
Mailing Address - Fax:510-465-1332
Practice Address - Street 1:411 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610
Practice Address - Country:US
Practice Address - Phone:510-385-8619
Practice Address - Fax:510-465-1332
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01970ZMedicare PIN