Healthcare Provider Details

I. General information

NPI: 1851497440
Provider Name (Legal Business Name): IMPACT PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 CALIFORNIA ST SUITE #3
SAN FRANCISCO CA
94115-2464
US

IV. Provider business mailing address

3150 CALIFORNIA ST SUITE #3
SAN FRANCISCO CA
94115-2464
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-2319
  • Fax: 415-775-0852
Mailing address:
  • Phone: 415-775-2319
  • Fax: 415-775-0852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0PT218960
License Number StateCA

VIII. Authorized Official

Name: MRS. IRINA NOSOVA
Title or Position: DIRECTOR, PHYSICAL THERAPIST
Credential: P.T.
Phone: 415-883-8323