Basic Information
| Provider Information | |||||||||
| NPI: | 1588986194 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EMERY | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SERVICES | ||||||||
| OtherFirstName: | DBA: BAYSPORT | ||||||||
| OtherMiddleName: | THERAPY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 987 UNIVERSITY AVE STE 12 | ||||||||
| Address2: | |||||||||
| City: | LOS GATOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950327640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083957300 | ||||||||
| FaxNumber: | 4083957350 | ||||||||
| Practice Location | |||||||||
| Address1: | 12000 CARMEL COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921306101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585099600 | ||||||||
| FaxNumber: | 8585099611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2010 | ||||||||
| LastUpdateDate: | 02/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT34647 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 26599 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.