Provider Demographics
NPI:1154900850
Name:WISH PHYSICAL THERAPY AND WELLNESS
Entity type:Organization
Organization Name:WISH PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LORETZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:510-388-0713
Mailing Address - Street 1:1939 MELVIN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2026
Mailing Address - Country:US
Mailing Address - Phone:510-388-0713
Mailing Address - Fax:
Practice Address - Street 1:1939 MELVIN RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-2026
Practice Address - Country:US
Practice Address - Phone:510-388-0713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty