Provider Demographics
NPI:1174111777
Name:QUAN-TONG, MARK JOSHUA SANTOS (DPT)
Entity type:Individual
Prefix:
First Name:MARK JOSHUA
Middle Name:SANTOS
Last Name:QUAN-TONG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:QUAN-TONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2030 ADDISON STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2030 ADDISON STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-644-8031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT299428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist