Healthcare Provider Details

I. General information

NPI: 1386875052
Provider Name (Legal Business Name): PHYSICAL SARAH-PY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 BONITA AVE
PACIFICA CA
94044-3116
US

IV. Provider business mailing address

239 BONITA AVE
PACIFICA CA
94044-3116
US

V. Phone/Fax

Practice location:
  • Phone: 415-699-6854
  • Fax: 270-513-7454
Mailing address:
  • Phone: 415-699-6854
  • Fax: 270-513-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 25837
License Number StateCA

VIII. Authorized Official

Name: SARAH MICHELE NORTHROP
Title or Position: PHYSICAL THERAPIST, OWNER
Credential: M.P.T.
Phone: 415-699-6854