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Organization
MONTCLAIR PHYSICAL THERAPY, INC.
Active
Organization
MONTCLAIR PHYSICAL THERAPY, INC.
Active
Other names
Active Method Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
SICLALIX JIMENEZ (OFFICE MANAGER)
(510) 339-2116
Entity
Organization
Contact information
Practice address
473 34TH ST, OAKLAND, CA 94609-2815
(510) 339-2116
(510) 339-0647
Mailing address
473 34TH ST, OAKLAND, CA 94609-2815
(510) 339-2116
(510) 339-0647
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT13625
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ05096Z
BLUE SHIELD CA GROUP NUMB
CA
Enumeration date
07/14/2006
Last updated
08/06/2020
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