Provider Demographics
NPI:1396169090
Name:FRIEND, EARL IV (DPT)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:
Last Name:FRIEND
Suffix:IV
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 CLARKE ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3632
Mailing Address - Country:US
Mailing Address - Phone:510-388-9660
Mailing Address - Fax:
Practice Address - Street 1:270 INTERNATIONAL CIR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1130
Practice Address - Country:US
Practice Address - Phone:408-972-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-15
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist