=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174061444
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAUSALITO HEALING ARTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2017
-----------------------------------------------------
Last Update Date | 02/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85 LIBERTY SHIP WAY SUITE 103
-----------------------------------------------------
City | SAUSALITO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94965-3316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-332-6061
-----------------------------------------------------
Fax | 415-480-1313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 85 LIBERTY SHIP WAY SUITE 103
-----------------------------------------------------
City | SAUSALITO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94965-3316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-332-6061
-----------------------------------------------------
Fax | 415-480-1313
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | MARYALICE OSHANA BIONDI
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 415-332-6061
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------