1396044194 NPI number — G SPORTS PHYSICAL THERAPY, INC.

Table of content: (NPI 1396044194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396044194 NPI number — G SPORTS PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G SPORTS PHYSICAL THERAPY, INC.
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:
6
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:
1396044194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
332 PINE ST
Provider Second Line Business Mailing Address:
SUITE 610
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94104-3206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-732-5608
Provider Business Mailing Address Fax Number:
415-732-0345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
332 PINE ST
Provider Second Line Business Practice Location Address:
SUITE 610
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94104-3206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-732-5608
Provider Business Practice Location Address Fax Number:
415-732-0345
Provider Enumeration Date:
03/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GEE
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/PHYSICAL THERAPIST
Authorized Official Telephone Number:
415-732-5608

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)

  • Identifier: FE641A . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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