Healthcare Provider Details

I. General information

NPI: 1730531310
Provider Name (Legal Business Name): PACIFIC THERX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 BUSH ST
SAN FRANCISCO CA
94115-3121
US

IV. Provider business mailing address

2211 BUSH ST
SAN FRANCISCO CA
94115-3121
US

V. Phone/Fax

Practice location:
  • Phone: 650-851-1145
  • Fax: 650-851-9251
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. FIDE MALDONADO
Title or Position: BILLING MANAGER
Credential:
Phone: 650-851-1145