Ida L Coryell Hirst
Organization Active NPI Physical Therapist · Pleasanton, CA
NPI 1861494031 · NPPES record last updated Nov 29, 2016
Key facts
- NPI
- 1861494031
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT13904 (CA)
- Legal business name
- IDA L CORYELL HIRST
- Practice address
- 3908 Valley Ave
Ste B
Pleasanton, CA 94566-4872 - Phone
- (925) 417-8005
- Fax
- (925) 417-8881
- NPI assigned
- Jun 1, 2005
- Organization subpart
- No
Authorized official
- Name
- Ida L Coryell Hirst, PT
- Title
- Physical Therapist/Owner
- Phone
- (925) 417-8005
Practitioners 19
-
Ida L Coryell Hirst, P.T.
-
Kathrinamay Basa, PT
-
Michael Petrak, P.T.
-
Sherry Kim, DPT
-
Shahrin Ahmad, MPT
-
Gayle L Anderson, RPT
-
Monica Marie Carrazco, P.T.
-
Kelli Noriko Davis, P.T.
-
Jane Henderson Eversole, PT, MA
-
Christine Ann Flinn, P.T.
-
Kenneth Kuras, MSPT
-
France Lantier, PT
-
Azuka I Nwigwe, PT
-
Laura J Phillips, MPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040903000606 | CA | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 5890761514 |
Receives reassigned benefits from 9 practitioners Practice locations: Pleasanton, CA |
National Provider Directory
Locations
3718 Grand Ave
Ste 15
Oakland, CA 94610
Phone (510) 893-8878
3908 Valley Ave
Pleasanton, CA 94566
3908 Valley Ave
Ste B
Pleasanton, CA 94566
Phone (925) 417-8005
2276 Camino Ramon
San Ramon, CA 94583
Phone (925) 417-8005
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | PT13904 | CA | Yes |
Addresses
Primary practice location
3908 Valley Ave
Ste B
Pleasanton, CA 94566-4872
Mailing address
3908 Valley Ave
Ste B
Pleasanton, CA 94566-4872
Phone (925) 417-8005
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ16236Z | Other | CA | MEDICARE PTAN |
| PT13904 | Other | CA | PT LICENSE NUMBER |
Other providers in Pleasanton, CA
- Steven K Huynh
- Vien Huynh
- Virginia Y. Hwang
- Christopher Michael Hydock
- Rim Said Mohamed Ibrahim
- Valerie Iftikhar
- Ignacio Chiropractic, Prof. Corp.
- Bryan Wade Ignacio
- Faith Iheke
- Louella Ilog
All providers in Pleasanton, CA · Physical Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.