Provider Demographics
NPI:1609474675
Name:IQBAL, TANYA RUTH
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:RUTH
Last Name:IQBAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 ALVARADO RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1553
Mailing Address - Country:US
Mailing Address - Phone:925-528-8177
Mailing Address - Fax:
Practice Address - Street 1:3161 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2216
Practice Address - Country:US
Practice Address - Phone:510-796-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist