Organization Name: | MARIN SPORT AND SPINE PHYSICAL THERAPY |
NPI Number: | 1487800942 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICH WALDRON (OPERATIONS MANAGER) |
Mailing Address: | 810 College Ave Suite 6 Kentfield |
State: | CA US |
Postal Code: | 949042532 |
Phone Number: | 4156140590 |
Fax Number: | |
NPI Enumeration Date: | 08/14/2008 |
NPI Last Update Date: | 08/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |