Organization Name: | BG MEDICAL, INC |
NPI Number: | 1174598098 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT LESLIE BAKER (PRESIDENT PHYSICAL THERAPIST) |
Mailing Address: | 2322 Powell St Emeryville |
State: | CA US |
Postal Code: | 94608 |
Phone Number: | 5106535151 |
Fax Number: | 5106011358 |
NPI Enumeration Date: | 02/22/2006 |
NPI Last Update Date: | 06/30/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | PT13568 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |