Provider Demographics
NPI:1396872701
Name:LIN, ALEXANDER (PTA)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2850 7TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2703
Mailing Address - Country:US
Mailing Address - Phone:510-295-9857
Mailing Address - Fax:510-845-0486
Practice Address - Street 1:2850 7TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2703
Practice Address - Country:US
Practice Address - Phone:510-295-9857
Practice Address - Fax:510-845-0486
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA3149225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant