Healthcare Provider Details

I. General information

NPI: 1790541332
Provider Name (Legal Business Name): GREGORY DARE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3129 VICENTE ST
SAN FRANCISCO CA
94116-2740
US

IV. Provider business mailing address

2767 SAN BRUNO AVE
SAN FRANCISCO CA
94134-1508
US

V. Phone/Fax

Practice location:
  • Phone: 415-661-1057
  • Fax:
Mailing address:
  • Phone: 415-290-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: