Provider Demographics
NPI:1104193671
Name:DAVID, TAI VICTORIA (DPT)
Entity type:Individual
Prefix:
First Name:TAI
Middle Name:VICTORIA
Last Name:DAVID
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TAI
Other - Middle Name:VICTORIA
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7907 OSTROW ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3635
Mailing Address - Country:US
Mailing Address - Phone:858-565-6910
Mailing Address - Fax:858-565-6911
Practice Address - Street 1:4748 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2034
Practice Address - Country:US
Practice Address - Phone:412-209-8046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CA38488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist