1184834517 NPI number — SC SPORTSTHERAPY

Table of content: (NPI 1184834517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184834517 NPI number — SC SPORTSTHERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SC SPORTSTHERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184834517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 NEW MONTGOMERY ST
Provider Second Line Business Mailing Address:
MEZZANINE
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94105-3412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-495-2273
Provider Business Mailing Address Fax Number:
415-896-2275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 SPEAR ST
Provider Second Line Business Practice Location Address:
#105
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94105-1673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-896-2273
Provider Business Practice Location Address Fax Number:
415-896-2275
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAM
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
415-896-2273

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC22827 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC0228270 . This is a "BLUE SHIELD PROVIDER ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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