| Sport Clinic Inc | |
|
39180 Farwell Dr, Suite 101, Fremont, CA 94538-1052 | |
| (510) 438-0294 | |
| (510) 438-0468 |
| Full Name | Sport Clinic Inc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 39180 Farwell Dr, Fremont, California |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497771901 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT18871 (California) | Primary |
| Provider Name | Michelle Keiko Nomura |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801951652 PECOS PAC ID: 9436127701 Enrollment ID: I20040923000928 |
| Provider Name | Darryl L Lopez |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831117266 PECOS PAC ID: 9234137969 Enrollment ID: I20061113000493 |
| Provider Name | Jason Lagmay Prestosa |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568837532 PECOS PAC ID: 0547567307 Enrollment ID: I20160323000706 |
| Provider Name | Trevor Daniel Dimich |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1093460701 PECOS PAC ID: 3173910577 Enrollment ID: I20220504001679 |
| Mailing Address | Practice Location Address |
|---|---|
| Sport Clinic Inc 39180 Farwell Dr, Suite 101, Fremont, CA 94538-1052 Ph: (510) 438-0294 | Sport Clinic Inc 39180 Farwell Dr, Suite 101, Fremont, CA 94538-1052 Ph: (510) 438-0294 |
Shweta Prakash Sadalge, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1895 Mowry Ave, Suite #118a, Fremont, CA 94538 Phone: 510-790-0383 Fax: 510-790-1197 | |
Ina Fitzgibbon, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 39210 State St, Ste 202, Fremont, CA 94538 Phone: 415-420-6127 | |
Judy Nalanganeagleton, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 39400 Paseo Padre Pkwy, Fremont, CA 94538 Phone: 510-248-3200 | |
Mr. Kyle Takeo Tanamachi, MPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 39400 Paseo Padre Pkwy, Fremont, CA 94538 Phone: 510-248-3504 | |
Katharin Kaczor, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 3800 Walnut Ave, #303b, Fremont, CA 94538 Phone: 510-742-9580 | |
Anju Sharma, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2942 Cheswycke Ter, Apt 157, Fremont, CA 94536 Phone: 602-773-1058 | |
Anuradha Hajarnis, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 39210 State St, Fremont, CA 94538 Phone: 510-790-9480 |