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Organization
IDA L CORYELL HIRST
Active
Organization
IDA L CORYELL HIRST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IDA L CORYELL HIRST PT (PHYSICAL THERAPIST/OWNER)
(925) 417-8005
Entity
Organization
Contact information
Practice address
3908 VALLEY AVE, STE B, PLEASANTON, CA 94566-4872
(925) 417-8005
(925) 417-8881
Mailing address
3908 VALLEY AVE, STE B, PLEASANTON, CA 94566-4872
(925) 417-8005
(925) 417-8881
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT13904
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT13904
PT LICENSE NUMBER
CA
01
—
ZZZ16236Z
MEDICARE PTAN
CA
Enumeration date
06/01/2005
Last updated
11/29/2016
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