Provider Demographics
NPI:1982777066
Name:EMANUEL, PHYLLIS R (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:R
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 HILLDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1317
Mailing Address - Country:US
Mailing Address - Phone:510-527-4374
Mailing Address - Fax:
Practice Address - Street 1:3075 CITRUS CIR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2666
Practice Address - Country:US
Practice Address - Phone:925-930-6680
Practice Address - Fax:925-930-7867
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7518174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist