Basic Information
| Provider Information | |||||||||
| NPI: | 1437692613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EHRLICHMAN | ||||||||
| FirstName: | DEVIN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 718 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941213806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598609464 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4341 PIEDMONT AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946114792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105471630 | ||||||||
| FaxNumber: | 5109231944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2016 | ||||||||
| LastUpdateDate: | 06/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT292128 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 13975025 | 01 | CAQH | OTHER | 292128 | 01 | CA | CALIFORNIA PHYSICAL THERAPY BOARD | OTHER |