Healthcare Provider Details

I. General information

NPI: 1194536094
Provider Name (Legal Business Name): JOANNE MARIE BEDWELL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 BENTON AVE
SAN FRANCISCO CA
94112-1103
US

IV. Provider business mailing address

81 BENTON AVE
SAN FRANCISCO CA
94112-1103
US

V. Phone/Fax

Practice location:
  • Phone: 415-335-1544
  • Fax:
Mailing address:
  • Phone: 415-335-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: