Provider Demographics
NPI:1154470664
Name:INNER BAR, INC.
Entity Type:Organization
Organization Name:INNER BAR, INC.
Other - Org Name:POTRERO PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-701-1000
Mailing Address - Street 1:P.O. BOX 410473
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94141
Mailing Address - Country:US
Mailing Address - Phone:415-701-1000
Mailing Address - Fax:
Practice Address - Street 1:550 15TH ST
Practice Address - Street 2:SUITE 36A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-5029
Practice Address - Country:US
Practice Address - Phone:415-701-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25650ZMedicare ID - Type Unspecified