Healthcare Provider Details

I. General information

NPI: 1821072067
Provider Name (Legal Business Name): COASTSIDE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 AURA VISTA DR
PACIFICA CA
94044-1848
US

IV. Provider business mailing address

PO BOX 612260
SAN JOSE CA
95161-2260
US

V. Phone/Fax

Practice location:
  • Phone: 650-355-4558
  • Fax: 650-355-4645
Mailing address:
  • Phone: 877-325-2776
  • Fax: 408-945-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANNE LASSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 408-570-0510