Provider Demographics
NPI:1992218887
Name:PILATES - PHYSICAL THERAPY & PILATES CORP
Entity type:Organization
Organization Name:PILATES - PHYSICAL THERAPY & PILATES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGDA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BOULAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:510-545-6586
Mailing Address - Street 1:2568 MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-5522
Mailing Address - Country:US
Mailing Address - Phone:510-717-4424
Mailing Address - Fax:
Practice Address - Street 1:2345 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2414
Practice Address - Country:US
Practice Address - Phone:510-545-6586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32202261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy