Healthcare Provider Details

I. General information

NPI: 1932865243
Provider Name (Legal Business Name): HALF MOON BAY PHYSICAL THERAPY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 09/02/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CABRILLO HWY S # 106D
HALF MOON BAY CA
94019-8200
US

IV. Provider business mailing address

225 CABRILLO HWY S # 106D
HALF MOON BAY CA
94019-8200
US

V. Phone/Fax

Practice location:
  • Phone: 650-440-4717
  • Fax: 650-440-4736
Mailing address:
  • Phone: 650-440-4717
  • Fax: 650-440-4736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: REYNA LUBACH
Title or Position: PRESIDENT
Credential: DPT
Phone: 650-440-4717