1790115376 NPI number — MCCARTHY'S INTERACTIVE PHYSICAL THERAPY, INC.

Table of content: DR. LAUREN ASHLEY GRAHAM MD (NPI 1538955927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790115376 NPI number — MCCARTHY'S INTERACTIVE PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCARTHY'S INTERACTIVE 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:
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:
1790115376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
927 VICENTE ST
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:
94116-3023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-665-4953
Provider Business Mailing Address Fax Number:
415-665-4953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
927 VICENTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94116-3023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-665-4953
Provider Business Practice Location Address Fax Number:
415-665-4953
Provider Enumeration Date:
11/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MCCARTHY
Authorized Official First Name:
LISE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
415-665-4953

Provider Taxonomy Codes

  • Taxonomy code: 2251G0304X , with the licence number:  25270 , 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)





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