Healthcare Provider Details

I. General information

NPI: 1558435727
Provider Name (Legal Business Name): ULTRAHEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MONTGOMERY ST SUITE 110
SAN FRANCISCO CA
94104-3402
US

IV. Provider business mailing address

220 MONTGOMERY ST SUITE 110
SAN FRANCISCO CA
94104-3402
US

V. Phone/Fax

Practice location:
  • Phone: 415-986-4979
  • Fax: 415-986-6951
Mailing address:
  • Phone: 415-986-4979
  • Fax: 415-986-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT8284
License Number StateCA

VIII. Authorized Official

Name: MRS. MARTHA MINJARES MATTOX
Title or Position: PHYSICAL THERAPIST OWNER
Credential: PT
Phone: 415-986-4979