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General NPI Number Information
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NPI Number | 1770537235
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Entity Type | Organization
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Legal Business Name | ESSENTIAL BALANCE PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 25 MITCHELL BLVD SUITE 2
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2007
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Country | US
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Telephone | 415-924-5700
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Fax | 415-924-5723
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Provider Business Mailing Address
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Address Line | 25 MITCHELL BLVD SUITE 2
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2007
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Country | US
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Telephone | 415-924-5700
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Fax | 415-924-5723
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Authorized Official
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Title or Position | OWNER/TREASURER
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Name | MS. BONNIE JEAN DAVIDSON
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Credential | PT
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Telephone | 415-924-5700
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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 |
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License Number State |
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