Basic Information
| Provider Information | |||||||||
| NPI: | 1588781231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BINGHAM | ||||||||
| FirstName: | DONOVAN | ||||||||
| MiddleName: | EMANUEL | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2712 MISSION ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154012750 | ||||||||
| FaxNumber: | 4154012774 | ||||||||
| Practice Location | |||||||||
| Address1: | 2712 MISSION ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941103104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154012750 | ||||||||
| FaxNumber: | 4154012774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/16/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT23673 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8126 | 01 | CBHS INTERNAL USE ONLY-COMMERCIAL NUMBER | OTHER | 8126 | 01 | SFGH INTERNAL USE ONLY | OTHER |