Provider Demographics
NPI:1083685333
Name:BAY AREA PHYSICAL THERAPY OF BENICIA INC
Entity Type:Organization
Organization Name:BAY AREA PHYSICAL THERAPY OF BENICIA INC
Other - Org Name:BENICIA BAY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-747-9977
Mailing Address - Street 1:560 1ST ST
Mailing Address - Street 2:SUITE D-101
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3295
Mailing Address - Country:US
Mailing Address - Phone:707-747-9977
Mailing Address - Fax:
Practice Address - Street 1:560 1ST ST
Practice Address - Street 2:SUITE D-101
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3295
Practice Address - Country:US
Practice Address - Phone:707-747-9977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03207ZMedicare ID - Type UnspecifiedMEDICARE PART B