Provider Demographics
NPI:1871779538
Name:TOMITA, JANICE E (RPT)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:E
Last Name:TOMITA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 REDWOOD HWY FRONTAGE RD STE 2175
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-6015
Mailing Address - Country:US
Mailing Address - Phone:415-381-0541
Mailing Address - Fax:415-381-0591
Practice Address - Street 1:591 REDWOOD HWY FRONTAGE RD STE 2175
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-6015
Practice Address - Country:US
Practice Address - Phone:415-381-0541
Practice Address - Fax:415-381-0591
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00PT97250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT97250Medicare PIN