Healthcare Provider Details

I. General information

NPI: 1023228053
Provider Name (Legal Business Name): MICHAEL VINCENT GADDINI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BUSH ST
SAN FRANCISCO CA
94104-3567
US

IV. Provider business mailing address

536 BURROWS ST
SAN FRANCISCO CA
94134-1422
US

V. Phone/Fax

Practice location:
  • Phone: 415-986-4979
  • Fax:
Mailing address:
  • Phone: 415-828-5254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number33252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: