Provider Demographics
NPI:1164501094
Name:QUANTUM PHYSICAL THERAPY
Entity Type:Organization
Organization Name:QUANTUM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:LESCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:415-381-8888
Mailing Address - Street 1:655 REDWOOD HWY
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3034
Mailing Address - Country:US
Mailing Address - Phone:415-381-8888
Mailing Address - Fax:415-381-8895
Practice Address - Street 1:655 REDWOOD HWY
Practice Address - Street 2:SUITE 309
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3034
Practice Address - Country:US
Practice Address - Phone:415-381-8888
Practice Address - Fax:415-381-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT272361Medicare ID - Type Unspecified
CAZZZ03211ZMedicare ID - Type UnspecifiedGROUP NUMBER