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General NPI Number Information
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NPI Number | 1205383213
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Entity Type | Organization
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Legal Business Name | LANDS END PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 44 GOUGH ST SUITE 308
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-5422
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Country | US
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Telephone | 917-703-3343
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Fax |
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Provider Business Mailing Address
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Address Line | 44 GOUGH ST STE 308
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-5424
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Country | US
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Telephone | 415-524-7390
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELINE CERRA
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Credential | PT
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Telephone | 415-524-7390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 22545
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License Number State | CA
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