1043873110 NPI number — PHYSERA PHYSICAL THERAPY GROUP, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043873110 NPI number — PHYSERA PHYSICAL THERAPY GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSERA PHYSICAL THERAPY GROUP, PC
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:
1043873110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2443 FILLMORE ST # 380-8130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94115-1814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-409-1407
Provider Business Mailing Address Fax Number:
800-991-2996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 CONCAR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94402-2681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-409-1407
Provider Business Practice Location Address Fax Number:
800-991-2996
Provider Enumeration Date:
04/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
FOREST
Authorized Official First Name:
CAROLE
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
650-796-2081

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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