Provider Demographics
NPI:1083190995
Name:THERAPYDIA CALIFORNIA PHYSICAL THERAPY, PC.
Entity Type:Organization
Organization Name:THERAPYDIA CALIFORNIA PHYSICAL THERAPY, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CLINIC SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NOTTINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-533-4863
Mailing Address - Street 1:18 E BLITHEDALE AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1946
Mailing Address - Country:US
Mailing Address - Phone:415-389-8677
Mailing Address - Fax:415-389-8695
Practice Address - Street 1:1821 SARATOGA AVE STE 100
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6606
Practice Address - Country:US
Practice Address - Phone:408-882-3451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty