MEDICARE: MR. MARAT DINER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT24004	CA

General Provider Information

NPI Number	:	1093800229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARAT DINER PT

Provider Business Mailing Address
First Line	:	2299 POST ST
Second Line	:	SUITE LL8
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3443
Country	:	US
Telephone Number	:	415-929-7677
Fax Number	:	415-929-7877

Provider Business Practice Location Address
First Line	:	2299 POST ST
Second Line	:	SUITE LL8
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3443
Country	:	US
Telephone Number	:	415-929-7677
Fax Number	:	415-929-7877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	12/10/2018

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