Healthcare Provider Details

I. General information

NPI: 1093719817
Provider Name (Legal Business Name): BAY AREA REHABILITATION MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HAYES ST
SAN FRANCISCO CA
94117-1013
US

IV. Provider business mailing address

2250 HAYES ST
SAN FRANCISCO CA
94117-1013
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5762
  • Fax:
Mailing address:
  • Phone: 415-750-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH B FECHTNER
Title or Position: PARTNER
Credential: MD
Phone: 415-750-5761