Organization
PERSONAL EDGE PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GINA MARY VILLA (ADMIN. DIRECOR / SECRETARY)
(925) 556-4310
Entity
Organization
Contact information
Practice address
7080 DONLON WAY, #108, DUBLIN, CA 94568-2787
(925) 556-4310
(925) 556-0375
Mailing address
7080 DONLON WAY, #108, DUBLIN, CA 94568-2787
(925) 556-4310
(925) 556-0375
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
PT 23848
CA
261QP2000X
Physical Therapy Clinic/Center
Primary
PT 34053
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ23426Z
MEDICARE PTAN
CA
01
—
ZZZ64073Z
BLUE SHIELD ID
CA
Enumeration date
11/06/2007
Last updated
06/18/2008
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