MEDICARE: JANET DALE GREEN BABB M.S., P.T.

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	171W00000X	Contractor	PT6675	CA

General Provider Information

NPI Number	:	1508994286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET DALE GREEN BABB M.S., P.T.

Provider Business Mailing Address
First Line	:	93 SPINDRIFT PSGE
Second Line	:
City	:	CORTE MADERA
State	:	CA
Zip	:	94925-1834
Country	:	US
Telephone Number	:	415-664-6061
Fax Number	:	415-927-7216

Provider Business Practice Location Address
First Line	:	4200 IRVING ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1223
Country	:	US
Telephone Number	:	415-664-6061
Fax Number	:	415-927-7216

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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