Provider Demographics
NPI:1932597465
Name:HONDA, ELWYN (PTA)
Entity Type:Individual
Prefix:MR
First Name:ELWYN
Middle Name:
Last Name:HONDA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 KILKARE RD
Mailing Address - Street 2:
Mailing Address - City:SUNOL
Mailing Address - State:CA
Mailing Address - Zip Code:94586-9438
Mailing Address - Country:US
Mailing Address - Phone:925-862-2375
Mailing Address - Fax:
Practice Address - Street 1:1628 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3020
Practice Address - Country:US
Practice Address - Phone:510-582-4636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4012225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant