Active NPI
Meredith Leslie Erin Fruchtenicht
- Pediatric Physical Therapist
- San Ramon, CA
National Provider Identifier
1598073397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- PT26775
- Practice address
- 2500 Old Crow Canyon Rd
Building 100 Suite 112
San Ramon, CA 94583-1623 - Phone
- (925) 362-0683
- NPI assigned
- Sep 15, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | PT26775 | CA | Primary |
Addresses
Primary practice location
2500 Old Crow Canyon Rd
Building 100 Suite 112
San Ramon, CA 94583-1623
Mailing address
2500 Old Crow Canyon Rd
Building 100 Suite 112
San Ramon, CA 94583-1623
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT26775 | CA | MD | Pediatric Physical Therapist |
| 26775 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284508800000",
"number": "1598073397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 OLD CROW CANYON RD",
"address_2": "BUILDING 100 SUITE 112",
"city": "SAN RAMON",
"state": "CA",
"postal_code": "945831623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 OLD CROW CANYON RD",
"address_2": "BUILDING 100 SUITE 112",
"city": "SAN RAMON",
"state": "CA",
"postal_code": "945831623",
"telephone_number": "925-362-0683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRUCHTENICHT",
"first_name": "MEREDITH",
"middle_name": "LESLIE ERIN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-15",
"last_updated": "2010-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "CA",
"license": "PT26775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Ramon, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.