Healthcare Provider Details

I. General information

NPI: 1306322094
Provider Name (Legal Business Name): PHYSICAL THERAPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 DIVISION ST STE 200
SAN FRANCISCO CA
94103-4892
US

IV. Provider business mailing address

290 DIVISION ST STE 200
SAN FRANCISCO CA
94103-4892
US

V. Phone/Fax

Practice location:
  • Phone: 415-529-8077
  • Fax: 415-869-2870
Mailing address:
  • Phone: 415-529-8077
  • Fax: 415-869-2870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. HEATHER MCGILL
Title or Position: OWNER
Credential: PT. DPT, SCS
Phone: 415-529-8077