Healthcare Provider Details

I. General information

NPI: 1205221256
Provider Name (Legal Business Name): BEACON PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BATTERY ST SUITE 802
SAN FRANCISCO CA
94111-5505
US

IV. Provider business mailing address

22 BATTERY ST SUITE 802
SAN FRANCISCO CA
94111-5505
US

V. Phone/Fax

Practice location:
  • Phone: 415-772-0997
  • Fax: 415-772-0997
Mailing address:
  • Phone: 415-772-0997
  • Fax: 415-772-0997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number41675
License Number StateCA

VIII. Authorized Official

Name: DR. CHARLES WESLEY KING
Title or Position: OWNER
Credential: DPT, FFMT, FAAOMPT
Phone: 415-772-0997