Provider Demographics
NPI:1295943587
Name:ELLEN BIER PHYSICAL THERAPY
Entity type:Organization
Organization Name:ELLEN BIER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:SHIRLEY
Authorized Official - Last Name:BIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:510-843-9110
Mailing Address - Street 1:3031 TELEGRAPH AVE
Mailing Address - Street 2:STE 131
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2051
Mailing Address - Country:US
Mailing Address - Phone:510-843-9110
Mailing Address - Fax:510-843-9110
Practice Address - Street 1:3031 TELEGRAPH AVE
Practice Address - Street 2:STE 131
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2051
Practice Address - Country:US
Practice Address - Phone:510-843-9110
Practice Address - Fax:510-843-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11806261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ09236ZOtherBLUE SHIELD PROVIDER #
CAZZZ30105ZMedicare ID - Type UnspecifiedPROVIDER NUMBER