1689764417 NPI number — JONATHAN SHERWOOD MSPT,ATC,MA,CSCS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689764417 NPI number — JONATHAN SHERWOOD MSPT,ATC,MA,CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERWOOD
Provider First Name:
JONATHAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSPT,ATC,MA,CSCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689764417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2999 REGENT ST
Provider Second Line Business Mailing Address:
STE 225
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94705-2190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-704-7760
Provider Business Mailing Address Fax Number:
510-704-7765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2999 REGENT ST
Provider Second Line Business Practice Location Address:
STE 225
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94705-2190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-704-7760
Provider Business Practice Location Address Fax Number:
510-704-7765
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  325055 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com