Healthcare Provider Details

I. General information

NPI: 1699844050
Provider Name (Legal Business Name): MARINDALE MEDICAL THERAPY UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/27/2023
Certification Date: 05/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 DEL GANADO RD
SAN RAFAEL CA
94903-2310
US

IV. Provider business mailing address

3240 KERNER BLVD
SAN RAFAEL CA
94901
US

V. Phone/Fax

Practice location:
  • Phone: 415-479-2203
  • Fax: 415-446-4476
Mailing address:
  • Phone: 415-473-6893
  • Fax: 415-473-6396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NANCY ADUNA
Title or Position: CHIEF THERAPIST
Credential: P.T.
Phone: 415-473-6893