| Organization Name: | ACTIVE MARIN PHYSICAL THERAPY INC |
| NPI Number: | 1184852766 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CYNTHIA LEWTON DEHAN (PHYSICAL THERAPIST) |
| Mailing Address: | 5 Bon Air Rd #c116 Larkspur |
| State: | CA US |
| Postal Code: | 949391143 |
| Phone Number: | 4152252923 |
| Fax Number: | 4159241770 |
| NPI Enumeration Date: | 06/23/2009 |
| NPI Last Update Date: | 07/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 24013 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |