Provider Demographics
NPI:1538202718
Name:EMBODY, JOHN (PTA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:EMBODY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5266 KATRINA CT
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-2540
Mailing Address - Country:US
Mailing Address - Phone:510-583-7858
Mailing Address - Fax:
Practice Address - Street 1:13939 E 14TH ST
Practice Address - Street 2:STE. #150
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2613
Practice Address - Country:US
Practice Address - Phone:510-343-8300
Practice Address - Fax:510-343-8302
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT3719225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant